Reader response: Behavioral interventions as a treatment for epilepsy: A multicenter randomized controlled trial.

Abstract

I read with interest the Haut et al.1 study on neurobehavioral interventions as a treatment for medication-resistant epilepsy. The complex relationship between stress and seizures is unclear. While stress is not thought to cause epilepsy, it is presumed that it makes preexisting seizure disorder worse and this forms the basis for advising stress reduction techniques to epilepsy patients. Patients commonly report more seizures when they are passing through a stressful period but there is no evidence that stress causes more seizures or makes preexisting seizure disorder worse. Until we have solid evidence to prove causality of stress as a seizure precipitant, the study only proves that with neurobehavioral interventions designed to reduce stress, patients report fewer seizures. It would be useful if portable (ambulatory) EEG recording systems were utilized instead of patient e-diaries to quantify seizure frequency change after neurobehavioral interventions.