{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:42:32Z","timestamp":1792226552900,"version":"4.4.0"},"reference-count":43,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Psychological stress is commonly reported as a seizure precipitant in epilepsy, yet evidence from major crises remains limited and inconsistent. We examined whether the October 2023 Israel\u2013Hamas conflict affected acute seizure\u2010related healthcare utilization among adults with epilepsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 34\u2009941 adults with established epilepsy (International Classification of Diseases, Tenth Revision [ICD\u201010]\u2009G40 diagnosis \u2265\u20092\u2009years prior) using the Clalit Health Services database in Israel. We compared seizure\u2010related emergency department (ED) visits in two 1\u2010year windows: pre\u2010war (October 1, 2022\u2013October 6, 2023) vs during\u2010war (October 7, 2023\u2013October 1, 2024). Primary outcome was ED visit rate per person\u2010year. Given non\u2010normal distributions, paired Wilcoxon tests assessed rate changes. Multivariable logistic regression identified predictors of worsening (during &gt; pre), and Cox proportional hazards modeling evaluated time\u2010to first ED visit, adjusting for demographics, socioeconomic status (SES), and comorbidities including dementia and post\u2010traumatic stress disorder (PTSD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall 3056 patients (8.8% of cohort) experienced a during\u2010war ED visit. Cohort\u2010level visit rates were similar across periods (224.13 vs 217.34 per 1000 person\u2010years; rate ratio .97, 95% confidence interval [CI] .94\u20131.00). Among 1039 patients with ED visits in both periods, median within\u2010patient change was negligible (\u22120.003 visits per person\u2010year), but the distribution shifted toward lower wartime rates (Wilcoxon\n                      <jats:italic>Z<\/jats:italic>\n                      \u2009=\u2009\u22123.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.002; paired\n                      <jats:italic>t<\/jats:italic>\n                      test\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.730). Dementia and older age were associated with the shift was toward lower wartime rates. Odds of worsening were negligibly higher with age (odds ratio [OR]\u2009=\u20091.007). Older age (hazard ratio [HR]\u2009=\u20091.03) and dementia (HR\u2009=\u20091.20) predicted earlier ED visits, whereas PTSD (HR\u2009=\u2009.73) and higher SES (HR\u2009=\u2009.82) reduced hazard.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>War\u2010related stress correlated with stable seizure\u2010related acute care utilization, with minor redistribution among recurrent ED users. Older age and dementia identify vulnerable subgroups requiring enhanced monitoring during national emergencies. Targeted monitoring and clinical support for high\u2010risk patients with epilepsy may help reduce acute seizure\u2010related ED utilization during high\u2010stress situations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70380","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T13:00:53Z","timestamp":1783515653000},"page":"5489-5500","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological stress during wartime and its association with seizure\u2010related emergency department utilization"],"prefix":"10.1002","volume":"67","author":[{"given":"Anda","family":"Eilam","sequence":"first","affiliation":[{"name":"Department of Neurology Kaplan Medical Center  Rehovot Israel"},{"name":"Faculty of Medicine Hebrew University of Jerusalem  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