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. 2025 Jun;66(6):2089-2098.
doi: 10.1111/epi.18331. Epub 2025 Feb 28.

Factors influencing seizure induction in patients with intracranial EEG recording

Hina Dave  1 , Morgan McCreary  1 , Antonio Guerra  1 , Michael R Sperling  2
Affiliations

Factors influencing seizure induction in patients with intracranial EEG recording

Hina Dave et al. Epilepsia. 2025 Jun.

Abstract

Objective: To shorten inpatient epilepsy monitoring unit (EMU) stays during epilepsy surgery evaluation, physicians utilize techniques to induce seizures including antiseizure medication (ASM) reduction, sleep deprivation, and chemical stimulation. We assessed the relative efficacy of these techniques.

Methods: We reviewed data from patients admitted for intracranial video-EEG (electroencephalography) evaluation at a single center. Demographics, baseline seizure frequency, seizure type, sleep deprivation, reduction in ASM, chemical stimulation method, and seizures were recorded. Statistical analyses were performed in R with survival analyses.

Results: A total of 209 patients were evaluated. We observed an increase in the risk of seizure occurrence of 1% for every increase of one seizure per week of baseline seizure frequency (confidence interval [CI] = 1.00-1.02, p = .009). Complete cessation of both sodium channel and non-sodium channel ASMs increase the rate of seizure occurrence (CI = 1.46-2.08, p < .0001 and CI = 1.28-1.80, p < .0001, respectively). A partial reduction in sodium channel drugs within 24 h of admission or previous seizure in the EMU increased seizure risk by 40% (CI = 1.18-1.72, p = .0002). For each seizure occurring during admission, the risk of seizure recurrence increased by 5% (CI = 1.03-1.08, p < .0001). Patients with temporal lobe epilepsy exhibited a 19% lower risk of seizures within the initial 24 h of admission than patients with extratemporal seizures (CI = .68-.97, p = .02). Neither chemical stimulation nor sleep deprivation impacted seizure risk.

Significance: We found that ASM reduction was the only method that effectively induced seizures in hospitalized patients; sleep deprivation and chemical induction failed to do so. Prospective studies are needed to further understand these induction methods.

Keywords: antiseizure medication; chemical stimulation; epilepsy; intracranial EEG; seizure induction; sleep deprivation.

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Conflict of interest statement

Hina Dave has served as a consultant/advisory board member for Medtronic, Neurelis, and UCB Pharma. She has received research support from Engage Therapeutics, UCB Pharma, and Xenon. Michael R. Sperling has received compensation for speaking at continuing medical education (CME) programs from Medscape. He has consulted for Medtronic and Neurelis. He has received research support from Medtronic, SK Life Science, Takeda, Xenon, Cerevel, UCB Pharma, Janssen, Equilibre, Epiwatch, Byteflies, and Biohaven. He has received royalties from Oxford University Press and Cambridge University Press. The remaining authors do not have any relevant conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Patient selection occurred between the dates of 2014 and 2021. ASM, antiseizure medication.
FIGURE 2
FIGURE 2
Length of stay, sleep deprivation, and/or chemical stimulation and seizure induction. The figure depicts the patients who received sleep deprivation (green line), combined sleep deprivation and chemical stimulation (red line), or chemical stimulation (blue line) during their admission. Seizures are depicted by the open circle, and the closed circle indicates the last seizure seen. The length of stay is determined by the closed square depicting the last observation.
See this image and copyright information in PMC

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