Stress and epilepsy

This paper reviews Literature in both the clinical and basic sciences that evaluates the relationship between stress and seizures. Most of the clinical studies are retrospective and anecdotal, and the few studies we have reviewed do not shed any clear light on the nature of the relationship. There are several inherent problems that render the cause-effect relationship between stress and seizures difficult to establish: (a) Stress is difficult to quantify, and there are marked individual differences; (b) stress can cause anxiety with hyperventilation, sleep deprivation, depression, noncompliance with antiepileptic drugs, increased alcohol intake, and all of these may, in turn, contribute to seizures; (c) seizures themselves can cause stress, which may subsequently aggravate seizures; and (d) EEG changes under stress fail to provide convincing evidence of increased epileptogenicity. In the review of the basic science research, we find no definite proconvulsant effects related to catecholamines, although we note possible associations of seizure/stress to corticotrophin-releasing factor (CRF), serotonin, ACTH, steroids, and GABA. (C) 1997 by Elsevier Science Inc. All rights reserved.