Seizure precipitants in children with intractable epilepsy

Purpose: To investigate the seizure precipitants in children with intractable epilepsy, and to determine any distinctive clinical features contributing to seizures in these patients. Methods: A questionnaire and seizure diary prepared by the parents of the patients. Demographic and seizure data were reviewed. Results: Of 120 patients with intractable epilepsy, 74 (62%) had one (n = 43), two (n = 23), or three seizure precipitants (n = 8). The three most common precipitants were illness or fever (32%), sleep deprivation (13%), and menstruation (10%). Of these precipitants, inducing factors (endogenous origin) were more common than triggering factors (exogenous origin): 73% versus 27%, respectively. Three distinctive clinical features - neurological abnormalities (P = 0.01), status epilepticus (P = 0.017), and abnormal neuroimaging (P = 0.007) - were significantly more common in patients with than in patients without precipitants. Conclusions: Prompt recognition and management of seizure precipitants has practical implications for treating patients with refractory epilepsy. Such patients can be counseled to avoid specific precipitants.