Are there real unprovoked/unprecipitated seizures?

Abstract

Resistant epileptic patients often experience seizure precipitating conditions. Their lack or presence is extremely important not only for the diagnosis of epilepsy but also for the most appropriate treatment of the seizures. Unfortunately, there are a lot of uncertainty in their evaluation occurring in the daily routine and the exact definitions for the practice are still lacking. Based on the consonant and contradictory aspects concerning the consideration of the seizure precipitant factors a new hypothesis is suggested: every clinical epileptic manifestation should need a tonic (chronic cerebral cortical epileptic dysfunction) and a phasic (acute epileptogenic noxa) condition simultaneously. Results of a pilot study aimed to evaluate the possible role of precipitants in the manifestation of habitual seizures of patients strengthened the hypothesis. The (34%) total population might be more sensitive to actual phasic epileptogenic changes and 5.5% who are considered as "seizure precipitant responders". The five most frequent precipitants provoked the patients' "habitual" seizures were: unexpected life events (29.6%), changes in drug intake (23.7%), insomnia (20%), meteoropathological effects (17%) and alcohol consumption (9.5%). The paper lists the evidences and practical experiences supporting the hypothesis and mentions some counter arguments. In conclusion, the acceptance of the hypothesis might open new perspectives in the complex antiepileptic therapy especially for the subpopulation most vulnerable of phasic epileptogenic conditions (about 5-6% of the total). Further investigations are recommended to elucidate the remaining theoretical and practical reservations.