Occurrence of seizures in association with work-related stress in young male army recruits

Purpose: To examine the risk of undergoing an epileptic seizure as a function of differing levels of occupational stress (physical and mental) in new military recruits with no previous history of epilepsy or with epilepsy in remission for over 2 years. Methods: The medical records of over 300,000 18-year-old men recruited to the Israeli army between mid-eighties and mid-nineties were used to assemble a cohort, which was followed for a period of 30 months. The severity of epilepsy at recruitment was determined according to four categories, 0 (no history of seizures) and 1-3 (history of seizures with different relapse-free periods, with or without treatment). The soldiers were subdivided according to their occupational categories to: combat units (CU), maintenance units (MU), and administrative units (AU). Results: The annual incidence rates per 100,000 in category 0 were 317, 298, and 401 in AU, MU, and CU, respectively. The incidence of seizures in category 0 was higher (relative risk [RR] = 1.29, CI = 1.03-1.62) in CU compared to AU and MU. No differences were found for seizure recurrence among various occupational groups. Conclusion: The increased risk of seizures in CU compared to AU and MU may indicate contribution of service conditions in CU, like physical and mental stress. The equivalent rates of seizure relapse, regardless of the type of occupation, suggests the need for minimal occupational restrictions for epilepsy patients who have been free of seizures for long periods.