Abstracts

Rationale: Specific stimuli can reliably trigger seizures in patients with epilepsy with a precise stimulus that is specific to a given patient. Patient ability to predict seizures, report triggers and techniques to stop partial seizures have received less attention. Methods: 223 epilepsy patients were prospectively surveyed in an outpatient epilepsy clinic. A diagnosis of localization-related epilepsy was based upon clinical grounds and supported by ancillary data. Solitary seizures, patients with IGE and SGE as well as those with PNES were excluded. A survey form administered to focus on patient subjective measures to predict seizure occurrence and address seizure triggers and maneuvers used to stop ongoing seizures. Patient demographics, predictability, specific triggers, termination efforts and techniques, and overall effectiveness of the maneuvers were evaluated. Results: 223 patients (90 males) aged 42.5 years of age had epilepsy for a mean duration of 20.2 years with an average of 4.3 seizures/month were evaluated. Treatments included a mean exposure to 6.0 AEDs (with 38/191 undergoing resective epilepsy surgery) though 74% of patients were uncontrolled. 47% of patients completed > 75% of the survey forms. 116 had definite auras. In this group, 63% independently noted auras with 39% of patients reporting auras in >75% of their seizures. 92 patients noted an ability to predict their seizures. Nearly ½ (43/92) of patients reported the ability to predict seizure onset > 75% of the time, with 19 (20.7%) predicting 50-75% of seizures, and 29 (31.6%) predicting their seizures < 50% of the time. Only 16% were positive that they could predict a seizure would occur within the next 24 hours while 21% felt they would not have a seizure in the next 24 hours. Triggers occurred in 76% of study patients. Stress/worry, sleep deprivation, and missed medication were most frequent. These were significantly more common that other triggers such as anger, illness, depression, fasting, alcohol consumption, hot water, smells, sounds, touch, dehydration, or no triggers (p=<0.0001). However, no differences were noted between the top 3 triggers (p= NS). Additionally, in this cohort 24/83 noted some ability to stop their seizures and 8% were positive that they could do so with maneuvers that were used. Termination techniques were reported to be effective (>75% certainty) in 34% (26/77). The primary maneuvers were taking extra anti-seizure medication (13/83) and lying down/resting (11/83). Conclusions: Almost ½ of patients with auras report the ability to consistently predict clinical seizure onset, while only 16% knew it would happen within 24 hours. More than 3/4th report seizure triggers with stress/worry noted most commonly, while nearly 1/3rd of patients also believe they could stop their seizures. Addressing patient beliefs may help to advance seizure prediction and termination in conjunction with other objective neurophysiologic methods.