Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures, which are essentially bursts of uncontrolled electrical activity in the brain. While the underlying cause of epilepsy can be varied, identifying what triggers an actual seizure event is a common concern for patients. The relationship between psychological stress and seizure occurrence is frequently reported by individuals with epilepsy. Stress is not generally considered a cause of the chronic condition itself, but it is a contributing factor that can increase the likelihood of a seizure in someone already diagnosed.
Stress as a Seizure Trigger
Stress rarely causes the development of epilepsy, but it is one of the most commonly identified triggers for seizures in people who already have the disorder. A seizure trigger is a factor that makes a seizure more likely to occur at a specific time. Stress lowers the brain’s threshold for a seizure without creating the underlying abnormal brain circuitry.
The type of stress experienced can affect its impact on seizure control. Acute stress is a sudden, intense reaction to a specific threat that can sometimes trigger a seizure. Chronic stress, involving prolonged anxiety, is generally considered more problematic for long-term management. Ongoing stress can create a difficult cycle, where the stress triggers seizures, and the unpredictability of seizures causes further anxiety.
The Physiological Link
The biological mechanism linking stress to a lowered seizure threshold involves the activation of the body’s stress response system, known as the Hypothalamic-Pituitary-Adrenal (HPA) axis. When a person perceives a threat, the hypothalamus releases corticotropin-releasing hormone (CRH), which signals the pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH then travels to the adrenal glands, prompting the release of the primary stress hormone, cortisol.
Elevated and sustained levels of cortisol, particularly in chronic stress, are thought to increase neuronal excitability within the brain. This hormonal activity interferes with inhibitory neurotransmitters, such as Gamma-Aminobutyric Acid (GABA). GABA typically acts to calm brain activity, but reduced effectiveness leads to an imbalance favoring hyperexcitability. This physiological cascade increases seizure susceptibility by destabilizing the brain’s electrical balance.
Distinguishing Epileptic Seizures from PNES
It is important to distinguish between true epileptic seizures (ES) and Psychogenic Non-Epileptic Seizures (PNES), sometimes called dissociative seizures. PNES are physical events that strongly resemble epileptic seizures but are not caused by abnormal electrical discharges in the brain. Instead, these episodes are a manifestation of severe psychological stress, trauma, or emotional distress.
PNES do not involve electrical hyperactivity and thus do not respond to anti-epileptic medications, which is why accurate diagnosis is crucial for effective treatment. Distinguishing the two can be challenging because their physical presentations overlap. The gold standard for definitive diagnosis is Video-Electroencephalography (VEEG) monitoring, which records the event both visually and electrically. If a seizure-like event occurs while the VEEG shows no corresponding epileptiform activity, PNES is confirmed.
Clinical observations offer additional clues. PNES events may feature signs of emotional distress, gradual onset and termination, and rarely occur during actual sleep. Conversely, true epileptic seizures often have rapid onset and termination, and frequently result in post-seizure confusion or amnesia. A correct diagnosis ensures that patients are directed to appropriate therapies, such as psychotherapy for PNES, rather than unnecessary anti-epileptic drug adjustments.
Strategies for Stress Management and Seizure Control
Managing stress is an actionable strategy that can significantly improve seizure control for many individuals with epilepsy. Establishing consistent sleep hygiene is a practical step, as inadequate rest is a major stressor that independently lowers the seizure threshold. Aiming for a regular sleep schedule helps regulate the body’s natural rhythms and reduces physical stress on the brain.
Tracking journals can help identify specific situations or emotional states that precede a seizure, allowing for proactive management. Mindfulness techniques, such as meditation and deep breathing, are effective non-pharmacological methods for lowering generalized anxiety. Regular physical activity, like walking or yoga, is also beneficial because exercise alters brain chemistry to counter stress effects. Consulting a specialized therapist for cognitive behavioral therapy (CBT) or biofeedback provides structured techniques for managing emotional and physiological responses to stress.