Stress and Seizures: Exploring the associations between stress and epileptic and psychogenic non-epileptic seizures

Stress is one of the most frequently self-identified seizure precipitants in patients with epilepsy, and psychogenic non-epileptic seizures (PNES) are by definition associated with psychological distress. Stress is a multifaceted phenomenon, yet few studies have systematically examined its different components in patients with seizures. The main aim of this thesis was therefore to assess the association between stress and seizures using a combination of stress measures, and to develop an intervention targeting stress in patients with seizures. The first study prospectively explored a range of psychological and physiological stress markers in patients undergoing video-telemetry. A diurnal pattern was observed in the physiological measures but, whereas some of the physiological measures were shown to be associated with each other, no close relationship was found with self-reported stress. Notably, none of the stress measures predicted occurrence of epileptic seizures or PNES; however, the occurrence of seizures was found to predict greater self-reported stress and autonomic arousal up to 12 hours after the seizures. A second part of the study assessed implicit attentional responses to stress-related stimuli and suggested patients with epilepsy show heightened vigilance towards threat (especially seizure threat), associated with increased autonomic arousal. A self-help stress-management intervention, developed as part of the second study, was evaluated in a pilot randomised controlled trial. Results from the pilot demonstrated the intervention was acceptable and provided preliminary evidence for its effectiveness in reducing self-perceived stress. Further evaluation in a larger trial may be justified, although future studies should include measures to reduce the high attrition rates observed in the pilot study. Ultimately, examination of the role of stress in seizure disorders continues to be an important area for future research. Simple interventions such as the one developed in this thesis could be a useful complementary treatment option for reducing the distress associated with seizures.