Abstracts

Rationale: Various behavioral interventions have shown promise in improving seizure control for epilepsy patients. Frontotemporal cortex is the most frequent focus of epileptic seizures and serves in emotion processing and decision making. A potential role of stress or emotions as seizure triggers has often been proposed with little evidence. Methods: The potential of emotions to function as seizure triggers, and the effect of relaxation on epileptic spikes were explored in 14 patients with focal epilepsy. 32 EEG recordings were obtained under conditions of evoked fear, anger or neutral emotion. Each emotional condition was followed by relaxation and a washout of 5 minutes each. Epileptic spikes in each segment were manually counted under blinded conditions. In addition to subjective reports of stress and drowsiness, physiologic measurements of continuous noninvasive blood pressure, ECG heart rate, respiration rate, temporal EEG theta power and facial EMG were obtained to assess physiologic changes during emotional stress and relaxation states. Results: Epileptic spikes increased during the fear condition as compared to neutral emotion (p = 0.013), and also increased during the relaxation technique as compared to baseline (p = 0.05). Decreases in blood pressure z scores, respiration rate and facial EMG all confirmed an effective relaxation. Physiologic changes during the fear condition included a drop in blood pressure z score, a marginal increase in heart rate and a marginal decrease in temporal EEG theta power z score. Conclusions: These preliminary findings suggest that stressful emotions such as fear can modulate epileptic spikes, which would support the notion that stressful emotions may function as triggers for partial seizures. The observation that epileptic spikes are increased during a state of relaxation is consistent with the known increase of spikes at the onset of sleep and may suggest that any beneficial effects of meditative relaxation on seizures may be similar to the effects of sufficient sleep: both temporarily increase epileptic spikes and may decrease seizures in the long term. This study was made possible with support from the Medical Research Foundation (MRF) grant number 0425 to S.M.E., NIH K23 AT01993-01 to S.M.E., NIH AT002656 and AT005121 to B.O., and the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1 RR024140 from the National Center for Research Resources (NCRR).