Early follow-up data from seizure diaries can be used to predict subsequent seizures in same cohort by borrowing strength across participants

Abstract

Accurate prediction of seizures in persons with epilepsy offers opportunities for both precautionary measures and preemptive treatment. Previously identified predictors of seizures include patient-reported seizure anticipation, as well as stress, anxiety, and decreased sleep. In this study, we developed three models using 30 days of nightly seizure diary data in a cohort of 71 individuals with a history of uncontrolled seizures to predict subsequent seizures in the same cohort over a 30-day follow-up period. The best model combined the individual’s seizure history with that of the remainder of the cohort, resulting in 72% sensitivity for 80% specificity, and 0.83 area under the receiver operating characteristic curve. The possibility of clinically relevant prediction should be examined through electronic data capture and more specific and more frequent sampling, and with patient training to improve prediction.

Methodological Issues in Studying Trigger Factors and Premonitory Features of Migraine

“…A summary of various methodological approaches to studying attack prediction along with their strengths and limitations is provided in Table . Studies of attack prediction are designed to link candidate predictors to the occurrence of headache attacks . The majority of studies simply ask patients to retrospectively recall their usual headache triggers or premonitory features.…”

“…A weakness is that a factor that is important and reliable for a particular individual, but rare in the population, may be missed. Combining individual and group‐level data may provide an optimal approach; we have recently shown that the combined approach is more useful in persons with epilepsy than either individual or group level models …”

“…Maintaining this type of diary will provide a wealth of information to both the health care provider and the patient, and help map out targets for behavioral intervention and help predict (and avoid) future attacks. Analysis of diary data to generate models that identify trigger factors and premonitory features requires sophisticated analytic approaches and large data sets …”

Depression, stress, epilepsy and adult neurogenesis

“…Epileptogenesis, on the other hand, might be exacerbated by excess hormone release during chronic stress or depression. Hippocampal neurons possess high levels of corticosteroid receptors (Reul and de Kloet, 1985; Herman et al, 1989; Cameron et al, 1993) and stress is the most cited seizure precipitant among patients with epilepsy (Temkin and Davis, 1984; Haut et al, 2007; Hall et al, 2009). Both corticotropin-releasing hormone and corticosterone increase neuronal excitability on the hippocampus, likely accounting for their ability to provoke seizures (Baram and Hatalski, 1998; Joëls, 2009).…”

Cognitive and metabolic correlates of emotional vulnerability in patients with temporal lobe epilepsy

“…Some authors consider this to be a subjective phenomenon caused by psychological predisposition, such as anxiety and/or depression trait, or certain patients' beliefs 7 8. Other studies have demonstrated a relationship between levels of daily experienced states of stress/anxiety and increasing risk of seizure the next day 3.…”