Blog #86: What We All Knew Is Now Documented: Stress & Missed Sleep Trigger Seizures

            According to a report presented at the 69^th Annual Meeting of the American Academy of Neurology, stress was found to be the most common trigger of seizures. Stress was linked to 37% of seizures in a study population. The research was led by Gregory Krauss, MD, Professor of Neurology at Johns Hopkins University and is summarized in the June 2017 issue of Neurology Reviews (www.neurologyreviews.com). Dr. Krauss and colleagues used an Apple Watch app called EpiWatch to track seizures over ten months. The app was created using Research-Kit, which was designed by Apple to aid researchers to gather this data.

            When the 598 participants perceived a seizure aura they would open the app. Then EpiWatch recorded heart rate and body movements for 10 minutes. The app asked the person to perform tasks to test responsiveness. The patient was asked to record seizure type, aura, loss of awareness and possible seizure triggers. The app also helped track medication use and drug side effects.

            Forty percent of the group tracked a total of 1,485 of their seizures. Information about the person’s opinion of a possible seizure-trigger was also tracked. The most common reported trigger was stress, linked to 37% of seizures. Participants also identified lack of sleep as a trigger for 18% of the seizures, menstruation for 12% and over-extension of their activities for 11%. Other reported triggers included diet (9%), missed medications (7%), and fever or infection (6%). Seizure triggers did not vary by the type of seizure.

            Those participants who worked full-time reported stress as the trigger in 35% of their seizures compared with 21% of seizures in part-time workers. The investigators found that unemployed people reported stress as a trigger in 27% and disabled people reported stress was a trigger in 29% of their seizures. Missed medication was a trigger in 40%, especially in younger people ages 16-25 years, while among older people ages 26-66, thirty-four percent reported missed medications as a trigger.

            The investigators hope to be able to use wearable technology to predict oncoming seizures.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Blog #53: New Studies: When Is It Safe to Drive With Epilepsy?

(This blog was originally posted on December 26, 2014)

 

 

 

 

 

            “I get an aura, a warning before my epileptic seizure, so that protects me and I can pull my car over and avoid an accident.” That’s what some people with epilepsy believe. Can these patients truly protect themselves and the driving public? There’s not enough information to make an accurate decision.

            An article in the December 4, 2014 issue of Neurology Today reviewed studies reported at the 2014 American Epilepsy Society Annual Meeting. The article concluded that neurologists and law-makers need to rethink current recommendations about driving with epilepsy. The American Academy of Neurology previously considered auras―“warnings”—that were consistent and prolonged to be a favorable feature in sanctioning a driving license. Recent studies question this belief: the aura did NOT protect the driver from an accident. Accident rates in people who have auras were similar to patients who did not have auras.

            In their study, patients underwent continuous video-EEG monitoring at the Yale Epilepsy Center while simulating “driving” on portable computer-based driving simulators, complete with brakes, gas, and a steering wheel. Researchers found that patients with longer seizures and seizures that led to a loss of consciousness were more likely to “crash” their vehicles in the simulated test compared to patients with other types of seizures without loss of consciousness (e.g., simple partial seizures). The research showed clearly that people who lose consciousness or have serious impairments in their movements during a seizure should not drive until treatment controls their seizures. Other patients whose EEG showed epileptiform discharges (these correlate with altered brain neuron-cell function) that did not alter consciousness or have other symptoms (subclinical EEG discharges) had vague, imprecise effects on driving. However, and very significantly, many patients who had lost consciousness did not know that their awareness was impaired during the “subclinical” EEG discharges when queried by the researchers.

            Some states leave the important decision of when to allow driving in people with epilepsy up to the neurologist. But in six states, California, Oregon, Nevada, Pennsylvania, New Jersey and Delaware, the state’s Department of Motor Vehicles makes the ultimate decision utilizing the physician’s—not necessarily a neurologist―input.

            With imprecise ability to determine if consciousness is preserved or not, neurologists need to be cautious in deciding whether a person who has epilepsy can drive safely. As noted above, there is still not enough information to make a highly accurate, sound decision about this important safety issue.

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel. It is a mother’s dramatic story that teaches epilepsy.