Predicting Seizures: A Behavioral Approach - 11/08/11

Doi : 10.1016/j.ncl.2009.06.002

Sheryl R. Haut, MD ^a,^⁎ , Richard B. Lipton, MD ^a,^b
^a Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York, NY 10467, USA
^b Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA

Corresponding author.

Résumé

This article reviews the clinical evidence for seizure prediction. The epilepsy cycle is considered, including the interictal, preictal, ictal, and postictal phases. Evidence suggesting that the preictal phase can sometimes be identified based on neurophysiologic signals, premonitory features, the presence of trigger factors, or self-report is discussed. Diary studies have shown that seizures are not randomly distributed in time and that a subgroup of persons with epilepsy can predict an impending seizure. Paper diary data and preliminary analysis of electronic diary data suggest that seizure prediction is feasible.

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Keywords : Seizure prediction, Premonitory features, Seizure precipitants, Trigger factors, Pre-ictal state

Plan

Issues in seizure prediction

The Epileptic Cycle and Seizure Prediction

Seizures are Not Randomly Distributed in Time

Candidate predictors of seizures

Electroencephalographic-based Approaches

Premonitory Features and the Prodrome

The Role of Trigger Factors/Seizure Precipitants

Patient Self-Prediction

Methodologic issues in studying seizure prediction

Selecting Patients for Seizure Prediction Studies

Distinguishing Within-person and Population Level Prediction

Diary Formats and Data Sampling Approaches

Adequately Sampling the Preictal State

Results of diary studies

Premonitory Features and the Prodrome

Trigger Factors or Precipitants

Patient Self-Prediction During the Preictal State

Building a predictive model

Prospects for preemptive therapy

Potential Pharmacologic Preemptive Treatments

Nonpharmacologic Preemptive Therapies

Precautionary Measures

Trigger Avoidance

Other Behavioral Techniques

Summary

Conflict of Interest Statement: Dr. S.R. Haut serves on the Speaker’s Bureau and Advisory Board of UCB Pharma. She has served as a paid consultant for Jazz and King Pharma, and has received grant support from Endo. Dr. R.B. Lipton has served as a consultant for, and received grant support from Pfizer and Endo.