Clinical features of the pre-ictal state: Mood changes and premonitory symptoms

Sheryl R. Haut, Charles B. Hall, Thomas Borkowski, Howard Tennen, Richard B. Lipton

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Identifying the pre-ictal state clinically would improve our understanding of seizure onset and suggest opportunities for new treatments. In our previous paper-diary study, increased stress and less sleep predicted seizures. Utilizing electronic diaries, we expanded this investigation. Variables were identified by their association with subsequent seizure using logit-normal random effects models fit by maximum likelihood. Nineteen subjects with localization-related epilepsy kept e-diaries for 12-14. weeks and reported 244 eligible seizures. In univariate models, several mood items and ten premonitory features were associated with increased odds of seizure over 12. h. In multivariate models, a 10-point improvement in total mood decreased seizure risk by 25% (OR 0.75, CI 0.61-0.91, p = 004) while each additional significant premonitory feature increased seizure risk by nearly 25% (OR 1.24, CI 1.13-1.35, p < 001) over 12. h. Pre-ictal changes in mood and premonitory features may predict seizure occurrence and suggest a role for behavioral intervention and pre-emptive therapy in epilepsy.

Original languageEnglish (US)
Pages (from-to)415-421
Number of pages7
JournalEpilepsy and Behavior
Issue number4
StatePublished - Apr 2012


  • Electronic diary
  • Localization-related epilepsy
  • Pre-ictal
  • Premonitory symptoms
  • Prodrome
  • Seizure diary
  • Seizure precipitants

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience


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