Environmental Seizure Triggers and Ongoing Seizure Activity in Adults with Epilepsy

INTRODUCTION: This study aimed to assess patient-perceived visual, auditory, and meteorological seizure triggers and examine their associations with ongoing seizure activity in adults with epilepsy.
METHODS: This single-center, cross-sectional study was conducted with 100 adults with epilepsy. We developed a structured researcher questionnaire, which was used to conduct face-to-face interviews and included 12 environmental stimuli. These were grouped as visual, auditory, and meteorological stimuli. Each stimulus was assessed using a 5-point Likert-type scale. These scores were assessed in relation to ongoing seizures. To understand the relationship between the perception of environmental stimuli and ongoing seizure activity, we performed multiple logistic regression analyses.
RESULTS: Sixty-one percent of participants (95% CI, 51.2–70.0%) reported at least one environmental stimulus as a trigger “sometimes or more often.” The most frequently reported stimuli were flashing lights (39%), bright sunlight (32%), sudden loud sounds (30%), and hot weather (30%). Participants with ongoing seizures had higher visual, meteorological, and total environmental trigger burden scores than those without ongoing seizures. Ongoing seizure activity was associated with the reporting of an external trigger (adjusted odds ratio [aOR]=9.93; 95% confidence interval [CI], 2.85–34.54; p<0.001). Each 5-point increase in the total environmental trigger burden score was associated with the occurrence of ongoing seizures (aOR=1.39; 95% CI, 1.02–1.88; p=0.035). Each additional ASM was independently associated with higher odds of ongoing seizure activity (aOR=2.36; 95% CI, 1.17–4.76; p=0.016).
DISCUSSION AND CONCLUSION: Many patients reported trigger stimuli when assessed in a structured manner. An increased environmental trigger load was shown to have an independent correlation with ongoing seizure activity. Therefore, a formal, structured assessment of environmental seizure triggers could provide additional information for routine epilepsy assessments. Prospective studies using validated assessment tools and objective exposure assessments are warranted to better define the possible clinical implications of these findings.

Keywords: Environmental seizure triggers, epilepsy, meteorological factors, seizure activity, seizure stimuli, visual stimuli.