Actress Melanie Griffith recently revealed that she was diagnosed with epilepsy following a string of seizures over a period of 20 years. Speaking at an event to raise awareness for Women’s Brain Health Initiative, Griffith said, “Every seizure that I had was at a point when I was extremely stressed.”

Griffith said she now has her condition under control with medication and hasn’t had a seizure in four years, which she partly attributes to the fact that she’s “not stressed anymore.”

But how big a role does stress actually play in epilepsy?

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. According to the Centers for Disease Control and Prevention, about 3 million adults and 470,000 children in the U.S. have epilepsy, with 150,000 new cases diagnosed every year.

For about half of people with epilepsy, the cause is unknown. In others, there are a few risk factors that are associated with epilepsy, including genetics, head injuries, brain tumors, developmental disorders, and infectious diseases (like meningitis, AIDS, and viral encephalitis).

Stress, on the other hand, has not been identified as a risk factor for epilepsy, but that doesn't mean there isn't some association between the two.

“While stress isn’t known to cause epilepsy, it’s possible it could trigger a seizure in someone who already has epilepsy,” Emily Levin, M.D., a neurosurgeon at the University of Michigan who specializes in epilepsy treatment, tells SELF. That said, evidence proving that stress triggers seizures in people with epilepsy is also sparse.

“We don’t know exactly why stress makes seizures come out in people with epilepsy,” says Dr. Levin, though she notes that there is some research in animals that suggests elevated stress hormones may be linked to changes in brain chemistry. "Research cannot confirm that stress is a trigger for seizures in people with epilepsy—it can only provide evidence that supports the conclusion. It may be that whatever causes the stress is also causing the increase in seizures—not the stress itself.”

Lack of evidence aside, the majority of people with epilepsy believe chronic stress or acute stress is a seizure trigger. Michael Privitera, M.D., professor and director at Cincinnati Epilepsy Center, University of Cincinnati, carried out a study of outpatients at an epilepsy center in 2014. Most of the patients reported acute stress (stress lasting minutes to hours) or chronic stress (stress lasting days to months) as their most common seizure trigger.

So, yes, it's possible that stress could trigger a seizure in someone with epilepsy, Houston Methodist neurologist Amit Verma, M.D., tells SELF. “However, if someone has never had a seizure before, stress alone is unlikely to be the trigger.”

If you have epilepsy, managing your stress may be one part of managing the disorder.

The outpatients who took part in Dr. Privitera’s study endorsed stress reduction techniques (such as yoga, exercise, and meditation) as highly successful self-treating methods.

For many people with epilepsy, stress can be the catalyst for a vicious cycle: they may be so anxious about having a seizure that they avoid certain situations or social interactions, which can increase their risk of depression, which can further exacerbate their stress. In these situations, Dr. Verma recommends personal and group therapy, antidepressants, and taking advantage of educational programs and resources at local Epilepsy Foundations.

And it's worth noting that the most common cause of a seizure in people whose seizures are well controlled with medications is missing a dose of that medication, said Dr. Verma. So if stress makes you more likely to miss a dose, that may be a contributing factor that needs to be addressed in order to manage your epilepsy.

Just as important as reducing stress is improving sleep health—and the two are closely linked.

“Stress or anxiety is seldom the sole cause of seizures, however, in some people it can make the seizures more frequent,” James Wheless, M.D., professor and chief of pediatric neurology of Le Bonheur Children’s Hospital in Memphis, Tennessee, tells SELF. “This is more likely to happen if the stress also causes them to lose sleep, as decreased sleep and sleep deprivation are major triggers for seizures."

According to the Epilepsy Foundation, the same “rules” for sleep hygiene apply to people with epilepsy and people without the condition. That includes getting enough sleep (between seven and nine hours, according to the National Sleep Foundation) and practicing good sleep hygiene, like: exercising regularly, avoiding too many daytime naps, maintaining a quiet and dark sleep environment, avoiding caffeine at least six hours before bedtime, limiting alcohol at night, and enjoying relaxing activities before bedtime.

Of course, it's impossible to live a completely stress-free life, especially if you live with epilepsy.

But being aware of what causes you stress and finding ways to manage that stress are crucial.

“The goal—even when in a stressful situation—is to try and eat regularly, get adequate rest, and take care of yourself,” says Dr. Wheless. Some people may benefit from other strategies to improve their anxiety, he adds, such as cognitive behavioral therapy, biofeedback, or relaxation techniques.

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