Premonitory features and seizure self-prediction: Artifact or real?

Epilepsy Center, University Hospital, Freiburg, Germany.
Epilepsy research (Impact Factor: 2.02). 11/2011; 97(3):231-5. DOI: 10.1016/j.eplepsyres.2011.09.026
Source: PubMed


Seizure prediction is currently largely investigated by means of EEG analyses. We here report on evidence available on the ability of epilepsy patients themselves to predict seizures either by means of subjective experiences ("prodromes"), apparent awareness of precipitants, or a feeling of impending seizure (self-prediction). These data have been collected prospectively by paper or electronic diaries. Whereas evidence for a predictive value of prodromes is missing, some patients nevertheless can forsee impending seizures above chance level. Relevant cues and practical implications are discussed.

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    • "While auras are part of the ictal event and participate in the detection of the onset of the seizure, prodromes are preictal, unaccompanied by objective EEG changes, but could also be used as alert symptoms by the patients [16] "
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    ABSTRACT: Despite the unpredictability of epileptic seizures, many patients report that they can anticipate seizure occurrence. Using certain alert symptoms (i.e., auras, prodromes, precipitant factors), patients can adopt behaviors to avoid injury during and after the seizure or may implement spontaneous cognitive and emotional strategies to try to control the seizure itself. From the patient's view point, potential means of enhancing seizure prediction and developing seizure control supports are seen as very important issues, especially when the epilepsy is drug-resistant. In this review, we first describe how some patients anticipate their seizures and whether this is effective in terms of seizure prediction. Secondly, we examine how these anticipatory elements might help patients to prevent or control their seizures and how the patient's neuropsychological profile, specifically parameters of perceived self-control (PSC) and locus of control (LOC), might impact these strategies and quality of life (QOL). Thirdly, we review the external supports that can help patients to better predict seizures. Finally, we look at nonpharmacological means of increasing perceived self-control and achieving potential reduction of seizure frequency (i.e., stress-based and arousal-based strategies). In the past few years, various approaches for detection and control of seizures have gained greater interest, but more research is needed to confirm a positive effect on seizure frequency as well as on QOL.
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