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Dr. Sheryl Haut is Director of the Adult Epilepsy Program and Director of Neurology Residency Training at Albert Einstein College of Medicine. Her research interests include: the temporal distribution of seizures, with emphasis on seizure clustering; seizure prediction and preemptive therapy; and alternative therapies for epilepsy. Dr. Haut has a Masters in Clinical Research Methods, and completed a K23 career development award from the NIH. She maintains an active adult epilepsy practice at Montefiore Medical Center, Moses Division.



Whether or not patients are able to reliably predict their own seizures was the subject of a study by Sheryl R. Haut, MD, and colleagues from the Comprehensive Epilepsy Management Center and Departments of Neurology at Montefiore Medical Center in New York and the Albert Einstein College of Medicine.

The objective of the study as noted in Neurology (2007;68:262-266)was “to examine seizure predictability in a cohort of adult patients using a prospective seizure diary study, to assess the validity of a patient’s prediction, and to determine if a subgroup of patients with epilepsy were able to reliably predict their seizures. The subjects were 18 years and older, had localization-related epilepsy, had more than 1 seizure within 12 months, and were able to self-maintain a seizure diary.” Seizure self-prediction was assessed by a rating scale: ‘Do you think you will have a seizure in the next 24 hours?’

On the basis of 71 subjects who returned 15,635 diary entries, the authors found that a positive prediction of seizures by patients was associated with a twofold increased risk of seizures.

A potential new treatment paradigm

Dr. Haut said, “We found that a significant sub-group of those with epilepsy were able to predict their seizures.” She pointed out that the people who kept the diaries were not trained or directed to pay attention to premonitory features.

Dr. Haut did note, however, that the next phase of the study will be more detailed. “We will repeat this study with an electronic diary that will detail triggers and features to get a better sense and understanding of what is driving a patient’s sense of an impending seizure. This is an exciting first step in a new treatment paradigm in epilepsy – namely preemptive therapy. In the future, we may be able to identify interventions, either medications or behavioral, to preempt a seizure at times of high risk.”

To prepare for a new study launch, Dr. Haut and her team are planning to look at specific internal states, moods, and exterior triggers to elucidate the association of premonitory features and attacks.

What types of questions will Dr. Haut ask in future studies?

“We will examine known seizure precipitants such as hours of sleep, menstruation, and stress to name a few. We are also always interested in a patient’s own assessment -- information which cannot be collected by a check-off. An interesting phenomenon I have found is that even if you do not provide a place for free text, many people will write their own thoughts all over the diaries. We anticipate that we will be successful in recruiting patients with epilepsy, many of whom are already keeping diaries. This group is always looking for explanations. We believe that this type of study will be very fruitful,” said Dr. Haut.

“Our research has the potential for reducing the unpredictability of seizures. Even just helping someone get a better sense of an upcoming seizure has merit,” she concluded.

Why the focus on seizure prediction?

Brian Litt, MD and Abba Krieger, PhD, in the same issue of Neurology explained in an editorial the importance of predicting seizures. “The single most problematic aspect of epilepsy, according to patients in one large survey, is the uncertainty about if and when a clinical event may occur. In addition, understanding seizure generation may enable new therapies, such as implantable devices, to help the one-third of the world’s 60 million patients with epilepsy whose seizures cannot be controlled by medication,” they said.

Litt and Krieger see challenging issues relating to the study, but acknowledge that it is “important both for its results and rigorous methods.” They added: “The authors have clearly done an excellent job assessing their data. But their conclusions must be considered in the setting of potential errors introduced by patient self-reporting.”

In speaking with epilepsy.com Dr. Litt said, “This is a great start and there is more to do. But Dr. Haut understands the potential for this type of investigation and this work holds a lot of promise.”

END

Authors of “Can patients with epilepsy predict their seizures?” include:

Sheryl R. Haut, MD, Charles B. Hall, PhD, Aaron J. LeValley, MA, and Richard B. Lipton, MD.

Edited by Steven C. Schachter, MD

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