Circadian patterns of pediatric seizures
T Loddenkemper1, M Vendrame, M Zarowski
1Harvard Medical School, Division of Epilepsy and Clinical Neurophysiology, Fegan 9, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA. tobias.loddenkemper@childrens.harvard.edu
Insights
Sleep and wakefulness patterns significantly influence seizure types and epilepsy localization in children. Understanding these circadian rhythms aids in better characterizing seizures and personalizing treatment strategies for epilepsy.
Area of Science:
- Neurology
- Epilepsy Research
- Sleep Medicine
Background:
- The relationship between circadian rhythms (sleep/wake, day/night) and epilepsy characteristics is not fully understood.
- Identifying patterns in seizure occurrence can improve diagnosis and treatment.
- Pediatric epilepsy presents unique challenges in understanding seizure triggers and localization.
Purpose of the Study:
- To investigate the association between sleep/wake cycles and diurnal patterns with specific seizure subtypes.
- To determine the correlation between these patterns and epilepsy localization in pediatric patients.
- To explore potential mechanisms underlying the non-random distribution of seizures.
Main Methods:
- Retrospective review of video-electroencephalography (V-EEG) data from 380 pediatric epilepsy patients.
- Analysis of 1,008 seizures, examining semiology, EEG localization, and timing (day/night, sleep/wake, 3-hour blocks).
- Statistical analysis to identify significant relationships between seizure characteristics and temporal patterns.
Main Results:
- Sleep and wakefulness were more reliable predictors of seizure semiology and localization than day/night cycles.
- Specific seizure types showed distinct patterns: auras, gelastic, dyscognitive, atonic, hypomotor, and epileptic spasms were more common during wakefulness, while tonic, tonic-clonic, automotor, and hypermotor seizures occurred more in sleep.
- Circadian patterns were observed for generalized, temporal, frontal, parietal, and occipital lobe seizures, with specific times of day/night associated with increased occurrence; frontal and parietal seizures were more frequent during sleep, independent of the time of day.
Conclusions:
- Sleep/wake states and time of day are crucial factors in characterizing seizure types and epilepsy localization.
- These findings enhance understanding of seizure distribution mechanisms.
- The results may inform the development of individualized treatment strategies for pediatric epilepsy.
Objective:
To evaluate the relationship of sleep/wake and day/night pattern to various seizure subtypes and epilepsy localizations.
Methods:
Charts of 380 consecutive pediatric patients with epilepsy undergoing video-EEG (V-EEG) over 2 years were reviewed for seizure semiology, EEG localization, occurrence during the day (6 am-6 pm) or night, during wakefulness and sleep, 3-hour time blocks throughout 24 hours, and various epilepsy localizations, and etiology.
Results:
A total of 1,008 seizures were analyzed in 225 children (mean age 8.5 ± 5.7 years). Sleep and wakefulness predicted seizure semiology and localization more reliably than daytime and nighttime. Auras, gelastic, dyscognitive, atonic, hypomotor, and myoclonic seizures, and epileptic spasms occurred more often in wakefulness, while tonic, tonic-clonic, automotor, and hypermotor seizures occurred more frequently in sleep (p < 0.05). Clonic, atonic, myoclonic, and hypomotor seizures occurred more frequently during daytime. Hypermotor and automotor seizures occurred more frequently at night (p < 0.05). Generalized seizures (6 am-12 pm), temporal lobe seizures (9 pm-9 am), frontal lobe seizures (12 am-6 am), parietal lobe seizures (6 am-9 am), and occipital lobe seizures (9 am-noon and 3-6 pm) revealed specific circadian patterns (p < 0.05). In addition, generalized and temporal lobe seizures occurred more frequently in wakefulness, while frontal and parietal seizures occurred more frequently in sleep, independent of day or night pattern (p < 0.05).
Conclusion:
Sleep and wakefulness, as well as time of day and night, are important considerations in proper characterization of seizure types and epilepsy localization. These findings may contribute to a better understanding of the mechanisms of nonrandom distribution of seizures, and may provide information for individualized treatment options.
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