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• W2133972801 abstract "To the Editors: Accurate evaluation of the influence of occasional seizure precipitating factors (SPF) in the clinical manifestation and course of epilepsy presents the researcher with a dilemma. On the one hand, lack of provoked seizures is one of the basic conditions for a diagnosis of epilepsy; on the other hand, the epileptic brain must be particularly sensitive to any phasic epileptogenic factors. In spite of a lack of strict medical evidence, experts have a great deal of information on the subjective significance of SPF in many patients. In some recent questionnaire-based surveys the majority of patients (or relatives) signalized at least one SPF preceding their habitual seizures (da Silva Sousa et al., 2005; Nakken et al., 2005; Sperling et al., 2007). The subjective nature of the patients' experiences means significant limitations of reliability of such studies. We recently obtained longitudinal data for 1,078 patients, including 4,012 control visits, equal to about 1,500 “patient-year” from the EPIMED 3.0 Hungarian Epilepsy Database (HED) (Rajna et al., 2001). The HED contains very detailed subdirectories for precipitants and provoking factors (Table 1). To validate patients' answers, we required them to include (qualitatively) the ratio of precipitated and unprovoked seizures during each interval. This indexing method allowed us to evaluate the consistency of the patients' reported experiences (for making their opinion more objective). Of the total population, 34% were sensitive to one or more precipitants. We found five meaningful SPF that provoked the patients' “habitual” seizures. Among these, unexpected life events (29.6%) and changes in drug intake (23.7%) were the most frequent SPF; presence of insomnia was observed in 20%, meteoropathological effects in 17% and alcohol consumption in 9.5% of the patients. Subgroups of epilepsies, seizure types, and severity and their regards to SPF were also treated statistically. No significant differences were shown among the subpopulations. There may be a smaller subgroup of patients in whom the applied antiepileptic treatment can eliminate only the risk of the unprovoked seizure because they are specially vulnerable to stronger or combined SPF. We have some 50 patients (5.5% of the population) belonging to this subpopulation. Patients who experienced one or more SPF in at least half of the intervals between two medical appointments were included in this target population (“seizure precipitant responders”). In our opinion optimal antiseizure therapy for these patients (and perhaps others), should include both increased efforts to recognize SPF and special therapeutic strategies for their avoidance or compensation, in addition to traditional pharmacotherapy or epilepsy surgery. Such treatment would increase the therapeutic potential and can help produce a better quality of life for the patients (at least in “responders”). Furthermore the approach provides new possibilities for the patients to contribute to their own therapeutic process. Conflict of interest: We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. None of the authors has any conflict of interest to disclose." @default.
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• W2133972801 date "2008-10-01" @default.
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• W2133972801 title "Are seizure precipitating factors underestimated in refractory epilepsies?" @default.
• W2133972801 cites W2010692367 @default.
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• W2133972801 doi "https://doi.org/10.1111/j.1528-1167.2008.01668.x" @default.
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