Most people encounter stress on a daily basis. In fact, a December 2017 Gallup Poll found that eight in 10 Americans are stressed and 79% of Americans reported feeling stressed sometimes or frequently through a typical day.
For some, stress is little more than a passing annoyance. For others, it can be debilitating. This is mostly due to how different people perceive and react to the stress in their lives. Different people have different points of view, different coping mechanisms, and different definitions of what stress actually is. What it means to one person may not be what it means to another and that is what can make it difficult to manage.
There is no denying that stress plays a part in our daily lives. But does it really affect epilepsy? Is stress a seizure trigger?
We asked Dr. Tricia Y. Ting, Professor of Neurology and Regional Director of Epilepsy at MedStar Georgetown University Hospital and she answered that question.
“There has long been anecdotal evidence that undue stress may trigger seizures in patients with epilepsy, she says. “Recent studies show evidence that stress-related hormone levels have been associated with changes in epileptic spike discharges in patients with epilepsy. So this association between stress hormone variation and neuronal excitability may explain the science behind what we are observing clinically.”
Stress and epilepsy
While stress can be a seizure trigger for some people, it is not a trigger for everyone. There are many different types of stress that affect the body, mind, or both. Dr. Ting explains, “Stress may come in many forms, physical and emotional, and vary in intensity. It can be caused by intense or prolonged physical exertion and exhaustion or may be caused by problems at work or home and adversely impact quality of sleep.”
Dr. Ting also notes that stress can compound certain problems, exacerbating psychological or physiological conditions that are already present. She says, “Stress may further augment anxiety and depression that can also contribute to drug or alcohol abuse or sleep deprivation that is a known trigger for seizures as well.”
A January 2017 article in the journal Seizure discussed stress-triggered seizures, noting that anxiety and depression tend to be higher in patients who are sensitive to stress.
Stress is not a universal seizure trigger for people with epilepsy, but some people do seem to be affected. Dr. Ting explains, “Some patients with epilepsy do seem to be more sensitive to stress than other, so stress is not a trigger for seizures in everyone.” She continues, “Those patients with epilepsy at most risk for seizures triggered by stress have likely noticed a pattern of having breakthrough seizures associated with a stress that was out of the ordinary for them, such as an unusual amount of sleep loss, physical exhaustion, hunger, or dehydration, or emotional spike from anger or grief, for instance.”
Some people may experience a seizure caused by stress, but it may not be an epileptic seizure. Dr. Ting discusses the very important difference.
“Stress may trigger seizures for some patients with epilepsy as we have detailed here, but this is not to be confused with “stress seizures” or what is more commonly known as psychogenic non-epileptic seizures (PNES).”
She continues, “These are not epileptic seizures, but more akin to panic or anxiety attacks that have a psychological basis and manifest as seizure-like attacks.”
A May 2017 article in Epilepsia cited a 2011 consensus clinical practice statement carried out by the Commission on Neuropsychiatric Aspects of Epilepsy of the International League Against Epilepsy (ILAE) that ranks PNES as one of the top three neuropsychiatric conditions with depression, anxiety, and psychotic disorder.
Stress isn’t the Same for Everyone
When most people think of stress the first thing that comes to mind are often traumatic events, being overloaded at work, or just having too much on your plate at one time. The daily stresses of work, home, kids, family, bills, and life in general can raise your stress level. While these stressors are well documented there are others that are often overlooked or not as well recognized that can occur:
- Change in barometric pressure
- Fluctuation in ambient temperature
- Air quality
- Ambient noise
- Bright lights
- Change in routine
- Illness (including minor illness like cold, indigestion, and allergies)
- Domestic partner is having a bad day
- Child struggling at school
There is also eustress which can occur in daily life but is often viewed in a positive light:
- Winning (or losing) a competition
- Getting married (or just being married or cohabitating)
- Getting a promotion at work
- Winning money
- Giving birth or becoming a parent
- Making new friends
There are any number of things that may stress you out, some you may not even realize or recognize as stressors. Dr. Ting elaborates on the snowball effect of stress, “Sometimes it’s the downstream effect from stress that results in sleep deprivation or unhealthy coping behaviors, such as alcohol abuse, that increases risk for seizures. For some women with epilepsy, they may notice increased seizures around their menstrual period that they may associate with the emotional stress of PMS (premenstrual syndrome), but that is more likely related to the effects of shifting sex hormone on their seizure threshold, called catamenial epilepsy.”
Talking to Your Doctor about Your Epilepsy and Stress
If you suspect that stress affects your epilepsy or is a seizure trigger, you should talk to your doctor. If you’ve been keeping a seizure journal, bring it with you so that you can review it together and discuss possible triggers and create a seizure management plan.
Dr. Ting has this advice for talking to your doctor about stress and seizures, “You should simply ask your doctor whether a trigger that you have noticed could be a risk for triggering your seizures. Then the doctor can consider it carefully with you on an individual basis.” She continues, “Sometimes what a patient or doctor believes is a trigger for their seizures is actually a random event that happens to occur before a seizure and is not truly a trigger.”
The bottom line here is when in doubt, ask. If you suspect that something is a seizure trigger, talk to your doctor about it.
Stress Management May Help Prevent Some Seizures
The first thing that doctors will usually recommend when they have a patient who is dealing with health problems associated with stress is to remove the stressor. While that is doable in some situations, it just isn’t always practical. You can’t just quit your job or get rid of your kids. You can’t just pick up and move to another state or grow a money tree in your back yard to alleviate your financial worries forever.
When a stressor isn’t so easily eliminated, you need other options. Your doctor can discuss certain strategies for you or may refer you to a specialist such as a counselor, nutritionist, or psychiatrist. It is important to find ways to relax even with the stress in your life. Some popular methods include:
“Reducing stress with practices that increase mindfulness, such as counseling, meditation and CBT, may positively impact seizure control in patients who are sensitive to stress,” says Dr. Ting. “And certainly moderate exercise is known to not only to benefit overall health but also to reduce stress. Medications such as antidepressants or anxiolytics may be necessary in some patients but only as recommended by their neurologist and psychiatrist.”
An article in Epilepsia in April 2017 found that mindfulness and other stress reducing interventions may not only lower a person’s stress levels but also prevent stress triggered seizures. The authors even proposed including it as an inexpensive adjunctive epilepsy treatment. The American Psychological Association’s Stress in America: The State of Our Nation report, the top four activities that respondents claimed helped relieve their stress included:
- Listening to music (47%)
- Exercise or walk (46%)
- Pray (29%)
- Medication or yoga (12%)
Find out what works best for you and incorporate it into your daily routine to reduce your stress levels.
If stress is adversely affecting you, even if it isn’t necessarily triggering your seizures, it is still important to get it under control and learn how to manage it properly. Stress can lead to other serious health conditions and affect how you function in your daily life. Most importantly, if you need help managing your stress, don’t be afraid to ask for it.
A major stressor with some is fear of not having anyone to help them in case of an event. SeizureLink recognizes sustained tonic muscle contractions that last at least 9 seconds. It then alerts the wearer's Caregivers so that they can quickly get the help they need. Wouldn’t you like the peace of mind knowing that you can get the support you need when you need it?
Tricia Y. Ting, MD, FAES
Professor of Neurology
Regional Director of Epilepsy
MedStar Georgetown University Hospital
Baldin, Elisa, et al. “Stress Is Associated with an Increased Risk of Recurrent Seizures in Adults.” Freshwater Biology, Wiley/Blackwell (10.1111), 18 Apr. 2017, onlinelibrary.wiley.com/doi/abs/10.1111/epi.13741.
Bin, et al. “Biofeedback for Everyday Stress Management: A Systematic Review.” Frontiers, Frontiers, 13 Aug. 2018, www.frontiersin.org/articles/10.3389/fict.2018.00023/abstract.
Gallup, Inc. “Eight in 10 Americans Afflicted by Stress.” Gallup.com, 20 Dec. 2017, news.gallup.com/poll/224336/eight-americans-afflicted-stress.aspx.
Kanemoto, Kousuke, et al. “PNES around the World: Where We Are Now and How We Can Close the Diagnosis and Treatment Gaps-an ILAE PNES Task Force Report.” Freshwater Biology, Wiley/Blackwell (10.1111), 23 June 2017, onlinelibrary.wiley.com/doi/full/10.1002/epi4.12060.
“Stress as a Seizure Precipitant: Identification, Associated Factors, and Treatment Options.” Egyptian Journal of Medical Human Genetics, Elsevier, 20 Dec. 2016, www.sciencedirect.com/science/article/pii/S1059131116303247.
“Stress in America Press Room.” Monitor on Psychology, American Psychological Association, www.apa.org/news/press/releases/stress/.
“Tricia Y. Ting, MD.” Department of Neurology | Georgetown University, neurology.georgetown.edu/faculty/ting.