I Kotwas, A McGonigal, A Trebuchon, M Bastien-Toniazzo, Y Nagai, F Bartolomei, J Micoulaud-Franchi. Epilepsy & Behavior 55(2016)157–164.

Purpose

While most seizures are unpredictable, many people report that they can anticipate when a seizure may happen. Some symptoms (such as auras, prodromes, or triggers) can alert a person that a seizure may occur. A person can then change a behavior to avoid injury or use cognitive and emotional strategies to try to control the seizure. This article reviewed the current state of knowledge for this issue.

Summary of Study Findings

Anticipating and predicting seizures: Studies have suggested that some people with epilepsy can predict a seizure because they have brief auras, longer “prodromes” before their seizure, or can identify precipitants that tend to cause their seizures.

The presence of auras allows behavioral modifications, such as sitting down or getting to a safe place before a seizure occurs. Identifying triggers, such as sleep deprivation, can help predict the likelihood of a seizure. However, controlled prospective studies have not necessarily found that prodromes or other symptoms reliably predict seizures. Perceived self-control and locus of control: People with epilepsy have better quality of life if they have higher perceived self-control.

Perceived self-control might be a pertinent aspect to enhance in people with epilepsy, whether or not they can actually control their seizures. External supports to detect, predict, or reduce seizures: Electronic diaries, seizure detection devices, and seizure-alert dogs help detect and possibly predict seizures.

Stress-based approaches such as cognitive-behavioral therapy, biofeedback, mindfulness, and yoga may reduce seizures through stress reduction or treatment of depression.

Combinations of these strategies are likely to be more effective.

What does this mean?

People with seizures that persist despite common therapies may be able to take advantage of nondrug strategies to improve their quality of life.

People with auras should recognize their value in alerting them to get to a safe place, such as sitting or lying down.

People with a prodrome they can recognize minutes or hours before a seizure can use that information to either prepare for the seizure or to try interventions to prevent the seizure, such as relaxation therapy.

People with epilepsy should use an electronic diary to track seizures and look for patterns. Also, consider a detection device as they become more sensitive and reliable.

Stress reduction through cognitive-behavioral therapy, biofeedback, mindfulness, and yoga should be considered by people who have any stress.

These strategies give people with epilepsy the opportunity to actively participate in gaining seizure control. Nondrug strategies may not work consistently or in all people, however.

Article published in Epilepsy & Behavior, February 2016