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This article was published in October 2012. The information may be out of date. Please check our epilepsy information or our site A-Z.

Congress report 3: SMILE: The new way to deal with stress

2 Oct 2012

A new initiative has been unveiled at the 10th European Congress on Epileptology. The initiative is a prospective study designed to explore better ways of dealing with stress in people with epilepsy. Ultimately, the aim of the study is to prevent seizures triggered by stressful situations.


The study was described in a session exploring stress and epilepsy by study leader Michael Privitera, Professor of Neurology at the University of Cincinnati, US. His research leads on from previous work by Hant et al, in which people with epilepsy were asked to fill in a questionnaire each day. The questions related to how they felt that day and what they thought were the chances that they would have a seizure within the next 24 hours.

Many study participants were unable to predict their own seizures. However, the study identified a subset of people with epilepsy whose ability to predict their own seizures was far more accurate than we might expect. This led Prof Privitera to wonder whether something is happening in the brain before a seizure that some people with epilepsy are able to pick up on.

Prof Privitera's study is entitled Stress Management Intervention for Living with Epilepsy - or, more appropriately, SMILE. Study participants will be prompted to use a smartphone app at certain times every day. The app will ask them to give scores for several psychological aspects - such as their worry levels or stress levels. This will allow the research team to assess the frame of mind of each person with epilepsy before and after their seizures.

The study also includes teaching participants several methods of managing stress in order to try and lower their seizure frequency. These methods include diaphragmatic breathing and progressive muscle relaxation. Prof Privitera also stressed the usefulness of techniques such as mindfulness. This is the process of being aware of the things that are happening around you and experiencing them more objectively, without allowing day-to-day stresses and worries to inform your thoughts.

The SMILE study is currently recruiting participants.



Stress, seizures and 9/11


Prof Privitera also outlined some very interesting facts about stress and its effect on people with epilepsy.

There is very mixed evidence about whether or not stress levels genuinely affect seizure frequency. Some studies have shown that stress levels do not trigger seizures. Others have shown that it only triggers seizures in some patient groups (some, for instance, only demonstrated an increase in the seizure frequency of male participants).

Interestingly, a study was performed in New York following the terrorist attacks on the World Trade Centre. After 9/11, the study demonstrated a 12 per cent increase in seizure frequency in those people with epilepsy living in Manhattan. The study further demonstrated that the people who were nearer the World Trade Centre experienced a greater increase in seizure frequency than those who were further away.



Stress or depression?


During the same presentation, Prof Privitera also called into question how we evaluate stress and whether it relates closely to other negative psychological effects. There are several characteristic behaviours that we would expect to see in someone experiencing either acute stress (in specific situations, such as an argument or a job interview) or chronic stress (in ongoing situations such as continued work stress or the breakdown of a relationship). These behaviours include things like being irritable, being tense, being restless or being impatient.

One previous study looked at these behaviours in a set of people with epilepsy who had a history of anxiety and depression and a set who did not. In every case, these behaviours were more apparent in people with epilepsy who had a history of anxiety and depression. This may suggest that there is a link between these behaviours and other psychiatric conditions in people with epilepsy.

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