Sheryl Haut, MD, Director, Montefiore Einstein Adult Epilepsy Program, alongside our colleagues at the University of Cincinnati and UCSF, conducted and completed the SMILE (Stress Management Intervention for Living with Epilepsy) study—the largest multicenter, randomized, controlled trial ever performed specifically to examine stress management to control seizures. The study uses smartphone diaries for pre-emptive epilepsy treatment of adults with medication-resistant focal epilepsy. We found that daily progressive muscle relaxation reduced stress, and patients who practiced daily progressive muscle relaxation and even patients who only kept detailed electronic diaries of their daily stress and mood had fewer seizures than before the trial. 

At Montefiore Einstein Comprehensive Epilepsy Center, we have been involved in studying the important relationship between stress and epilepsy for decades. Stress is the most common seizure trigger reported by patients with epilepsy, yet treating stress is not a standard component of epilepsy treatment. We have also been at the forefront of seizure diary studies, designed to examine the relationship between stress and seizures. Stress management, including appropriately chosen behavioral therapies, appears to be an important adjunct to standard epilepsy therapy.

Building on the information from the SMILE study, we have now included various forms of stress awareness and management into our treatment of epilepsy and are expanding our stress management program to help optimize seizure control and prevention. We review stressors and ways to monitor daily stress, provide various forms of stress reduction training, and we have grown our team this year to include two dedicated epilepsy social workers who participate in our stress reduction program. In our next phase of research, we plan to explore a wider range of stress reduction modalities, including measurement of stress indicators, such as heart rate and stress hormones, so that we can better develop a biologically-based, precision medicine program to manage stress and seizures and improve quality of life.