Lang Johannes D, Taylor David C, Kasper Burkhard S
Epilepsy Center, Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
The Institute of Child Health, Department of Neurology, University College London, London, WC1N 1EH, UK.
Epilepsy Behav. 2018 Mar;80:163-172. doi: 10.1016/j.yebeh.2018.01.005. Epub 2018 Feb 2.
In epilepsy, individual seizures can be triggered by a variety of external and internal stimuli. One of the most common trigger factors reported by patients is stress. However prevalent, stress-related triggering of episodes seems underappreciated in epilepsy for various reasons, and its misinterpretation often leads to other diagnoses, e.g., psychogenic nonepileptic seizures (PNES) or normal reactions. This article illustrates the significant role of stress as a seizure-provoking factor by referring to nine patient narratives. From this perspective, it appears that there are characteristic patterns of stress triggering, e.g., stress-induced sleep disruption, forms of acute stress, or relaxation after stress. Sometimes seizures are mistaken as symptoms of stress. Patient narratives contain interesting clues relating reports about stress and seizure histories to different epilepsy syndromes as well as nonepileptic episodes in a way that can strongly support the diagnostic process. A narrative approach is particularly valuable in this context. Therefore, accounts of stress triggering in seizures and other episodes should not be neglected, but rather taken seriously, sought and actively explored as a crucial element when taking clinical histories in patients with episodic attacks.
在癫痫中，个体发作可由多种外部和内部刺激引发。患者报告的最常见触发因素之一是压力。然而，尽管压力普遍存在，但由于各种原因，癫痫中与压力相关的发作触发似乎未得到充分重视，对其误解往往会导致其他诊断，例如精神性非癫痫发作（PNES）或正常反应。本文通过引用九个患者的叙述来说明压力作为发作诱发因素的重要作用。从这个角度来看，似乎存在压力触发的特征模式，例如压力导致的睡眠中断、急性压力形式或压力后的放松。有时发作会被误认为是压力症状。患者的叙述包含有趣的线索，将关于压力和发作史的报告与不同的癫痫综合征以及非癫痫发作联系起来，这种方式能够有力地支持诊断过程。在这种情况下，叙述方法特别有价值。因此，在发作和其他发作性事件中关于压力触发的描述不应被忽视，而应被认真对待，在对发作性发作患者进行临床病史采集时，应将其作为关键要素加以寻找和积极探索。
