Saint Nicholas and epileptic seizures
INTRODUCTION Stress is the most often reported seizure-precipitant in epilepsy (van Campen et al., 2014). Results from self-report questionnaires or diaries still need to be confirmed by larger scale studies. Although people may experience stressors of various nature at different times, some events induce stress in a large part of the population. A national celebration in the Netherlands that is often considered to be very stressful for children is Saint Nicholas (‘Sinterklaas’ in Dutch). Saint Nicholas, a historical figure closely related to Santa Claus, and his helpers, the ‘Black Petes’ (Figure 1), arrive by boat in the Netherlands around mid-November. This arrival is broadcasted on national television and demarks the beginning of a three-to-four-week stay. The myth says that Saint Nicholas and his helpers leave well-behaved children presents but punish those who have been naughty. Children sing songs to please the Saint, hoping to receive presents, which are left in their shoes at night. The celebration of Saint Nicholas’ anniversary on the 5th of December marks the end of his stay. The Saint Nicholas period is generally experienced as exciting and stressful, especially for children but also for adults (Helsloot, 2011). In a recent questionnaire study, the Saint Nicholas period was reported to increase seizure frequency in 16% of children with epilepsy (van Campen et al., 2012). Patients increasingly use search engines on the Internet to retrieve medical information (Dickerson et al., 2004), including information on epileptic seizures (Brigo et al., 2014). Therefore, Google queries can provide indirect, but accurate, estimates of incidences of diseases, such as epilepsy and epileptic seizures (Polgreen et al., 2008; Ginsberg et al., 2009; Carneiro and Mylonakis, 2009). In Figure 1. this study, we relate the stressful national celebration of Saint Nicholas and Black Pete People dressed like Saint Nicholas Saint Nicholas to epilepsy using epilepsy information- and Black Pete, photographed by DeEchteSint.nl. seeking behavior.
METHODS Data collection Epilepsy information-seeking behavior on the worldwide web was quantified using Google TrendsTM, a web tool of Google Inc., freely available at www.google.com/trends/. Google TrendsTM provides the search volume for entered queries per week, relative to the total number of queries performed on Google. On September 22, 2013, the relative search volume of the term ‘epilepsy’ or its appropriate translation (‘epilepsie’ in Dutch) were extracted for the Netherlands, the United States of America (USA) and the United Kingdom (UK)
67
4