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Advanced Neurology Seizure precipitants

Table 4. Distribution of seizure precipitants by age categories
Precipitating factor Age group (years) p‑value
<20 (%) 20 – 29 (%) 30 – 39 (%) 40 – 49 (%) ≥50 (%)
Emotional stress 29 (70.7) 42 (67.7) 29 (72.5) 15 (71.4) 14 (70) 0.990
Missing anti-epileptic dose 27 (65.9) 34 (54.8) 23 (57.5) 11 (52.4) 10 (50) 0.733
Sleep deprivation 14 (34.1) 19 (30.6) 15 (37.5) 5 (23.8) 6 (30) 0.848
Excessive sunlight exposure 20 (48.8) 10 (16.1) 13 (32.5) 5 (23.8) 5 (25) 0.009
Fatigue 11 (26.8) 10 (16.1) 12 (30 6 (28.6) 11 (55) 0.019
Auditory stimuli 9 (22) 3 (4.8) 10 (25) 5 (23.8) 2 (10) 0.028

Table 5. Pearson’s correlation coefficient for precipitants of epileptic seizures
Variables Emotional stress Missing anti‑epileptic dose Sleep deprivation Fatigue
Emotional stress 1 0.105 0.271** 0.212**
Missing anti-epileptic dose 0.105 1 0.172* 0.135
Sleep deprivation 0.271** 0.172* 1 0.313**
Fatigue 0.212** 0.135 0.313** 1
Notes: *Correlation is significant at the 0.05 level; **Correlation is significant at the 0.01 level.

date, more than 40 seizure-precipitating factors have been triggered by a precipitating factor in the past year of
reported by PWEs. 10,19 In this study, however, 94% reported follow-up. On the other hand, a slightly higher figure was
at least one seizure precipitant, and 77.7% of them reported documented in Ferlisi and Shorvon, in which 28% of the
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two or more precipitating factors, and the finding is similar patients claimed that 100% of their seizures were related to
to some previous studies. 12,19 The three most reported some precipitant factors.
seizure precipitants in our study were stress, missing Although many precipitating factors have been
anti-epileptic dose, and inadequate sleep, consistent with described in the literature, sometimes more than one factor
findings documented elsewhere. 10,12,15,20
can co-act, leading to a complex relationship between
The most frequent precipitating factor noted in this precipitating factors and the occurrence of seizures. For
study was emotional stress (70.1%). Similarly, Ferlisi and instance, emotional stress may further lead to excessive
Shorvon reported emotional stress as the most frequent alcohol drinking, non-compliance, and sleep deprivation,
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precipitating factor in 82% of cases (n = 104). In a Nigerian which, in turn, triggers the seizure. As expected, we
study, 53.3% of a cohort of 210 patients cited emotional also noted a similar association between stress, sleep
stress as a triggering factor of their seizure, which was deprivation, fatigue, and missing anti-epileptic dose in the
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also reported by 83% of 75 PWEs in a study conducted in present study.
Brazil. 18
In the present study, the second most frequent 6. Strengths and limitations of the study
precipitating factor was missing anti-epileptic dose, This study attempted to gather evidence on the first-time
concurring with findings reported by studies conducted in contextual seizure attack. In addition, a notable number of
Egypt (57.1 % vs. 56.4%) and Sudan (57.1 % vs. 41%). PWEs identified the factors that precipitate their seizures
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1
Sleep deprivation was found as the third most common and were able to reduce the frequency of seizure attacks by
precipitating factor in this study, a finding in agreement avoiding the identified factors. Nevertheless, the findings
with Al Kattan et al. (32.1% vs. 36.4%). Incidence rate of need to be interpreted cautiously since our study sites were
1
sleep deprivation reported in this study was almost similar limited to two facilities, which might not be representative
to those reported in the Netherlands (32.1% vs. 25.0%) and enough. One limitation of the study is the use of data
in Nigeria (32.1% vs. 30.0%) 10,13 However, when compared stemming from self-reporting of seizure precipitants,
with findings stemming from the Brazilian context, our particularly stress, which is challenging for objective
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finding is lower (32.1% vs. 77%). measurement. In addition, recall bias may have affected
Another important finding mentioned by about a the accuracy of participants’ responses regarding past
quarter of our PWE cohort is that their seizure was seizure-triggering events. To capture more precipitating

Volume 4 Issue 4 (2025) 63 doi: 10.36922/an.7679