Abstract
Various factors have been considered as potential seizure precipitants. We here assessed the temporal association of food intake and seizure occurrence, and characteristics of seizures and epilepsy syndromes involved. 596 seizures from 100 consecutive patients undergoing long-term video-EEG monitoring were analyzed. Preictal periods of 60 min were assessed as to the occurrence of food intake, and latencies between food intake and seizure onset were analyzed. Seizures of temporal origin were highly significantly more frequently preceded by food intake compared to those of extratemporal origin; and were associated with shorter food intake-seizure latency. Seizure precipitation by food intake showed male predominance. Shorter food intake-seizure latency was associated with less severe seizures and less frequent contralateral spread of epileptic discharges. We here show for the first time that not only in specific rare reflex epilepsies but in the most frequent form of focal epilepsy, temporal lobe epilepsy, seizures are significantly precipitated by food intake. Seizure occurrence was increased over a period of up to one hour following food intake, and remained more localized in terms of both ictal EEG spread and as reflected by seizure severity. This finding supports the emerging concepts of ictogenesis, implying a continuum between reflex and spontaneous seizures—instead a dichotomy between them.
Highlights
Various factors have been considered as potential seizure precipitants
Our data provide evidence that food intake is a significant seizure precipitant in patients with focal epilepsy of temporal origin, even if none of the patients fulfilled the old concept of reflex epilepsy
Triggering/precipitating factors can be categorized as either extrinsic or intrinsic[10]. If one such factor repeatedly and consistently triggers seizures, it is classified as a reflex seizure, where a strong temporal connection can be established between the triggering factor and the seizure occurrence: e.g. startle, music, photic, reading, hot water or—in this case—eating induced seizures[10]
Summary
Various factors have been considered as potential seizure precipitants. We here assessed the temporal association of food intake and seizure occurrence, and characteristics of seizures and epilepsy syndromes involved. 596 seizures from 100 consecutive patients undergoing long-term video-EEG monitoring were analyzed. Seizure occurrence was increased over a period of up to one hour following food intake, and remained more localized in terms of both ictal EEG spread and as reflected by seizure severity. This finding supports the emerging concepts of ictogenesis, implying a continuum between reflex and spontaneous seizures—instead a dichotomy between them. We here studied continuous video-EEG recordings in epilepsy patients to objectively assess temporal relationships between food intake and seizure occurrence in a large cohort of epilepsy patients to study food intake with its act of chewing and activation of the autonomic nervous system and the generation of focal-onset seizures. Results are discussed in the context of new seizure classifications and the changing concepts of “reflex” vs. “unprovoked” seizures
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