Seizure Precipitants

Abstract

In the comprehensive management of epilepsy, both preventive pharmacological treatment and awareness of possible seizure precipitating factors are important. The true cause of seizure generation is often hard to disentangle, as triggers often are obscure and occur in concert. This dissertation examines possible seizure precipitants in patients admitted to Department of Neurology and Clinical Neurophysiology, St Olav's Hospital, Trondheim University Hospital, July 2006-February 2010, soon after a seizure. The results from the study are presented in three papers. In paper I, preictal caffeine intake was compared to consumption in a seizure free period as animal models and case reports have suggested caffeine to contribute to seizure development. Dietary caffeine intake 24h prior to the seizure was not different compared to habitual intake or compared to intake in a seizure free period. Therefore, caffeine does not seem to be a common seizure precipitant in a clinical setting, and patients should be accordingly advised. Non-adherence persists as a major obstacle to optimal epilepsy treatment, but its magnitude has been difficult to determine. In paper II, patients with epilepsy acutely admitted for seizures were included, and concentration/dose ratios of AEDs at admission were compared with the patiant's own steady-state, drug-fasting control values.

Non-adherence was seen in 39%, and was more common in younger patients. Many patients seem to be unaware of missed drug intake. AED serum concentrations should be part of the emergency care. Efforts to improve treatment adherence is an important part of comprehensive epilepsy management. Sleep-time in the 24h prior to the seizure was assessed in paper III, and was found to be lower when compared to follow-up. Anxiety and depression did not correlate with differences in sleep time, but the interaction between alcohol and sleep was high. However, sleep loss stood out as an independent trigger. This study demonstrates that epileptic seizures usually seem to be precipitated by a combination of clinical factors.