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Published on: October 2, 2019
Predicting diurnal and sleep/wake seizure patterns in paediatric patients of different ages
Sriram Ramgopal1, Christine Powell2, Marcin Zarowski3
1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, Department of Pediatrics, The Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
Insights
Seizure timing in children changes with age and seizure type, with generalized seizures occurring more during the day and frontal lobe seizures more during sleep in adolescents. These findings may help predict seizure risk periods.
Area of Science:
- Pediatric Neurology
- Epileptology
- Circadian Biology
Background:
- Understanding seizure timing is crucial for managing epilepsy in children.
- Diurnal and sleep-wake patterns of seizures can vary significantly across age groups and seizure types.
Purpose of the Study:
- To investigate factors influencing diurnal and sleep/wake seizure timing in pediatric patients during drug withdrawal.
- To identify age-specific patterns in seizure occurrence.
Main Methods:
- Retrospective review of video-electroencephalography (EEG) data from 390 pediatric patients.
- Seizure timing analyzed in 3-hour intervals and categorized by sleep/wake states.
- Statistical analysis using generalized estimating equations to model seizure occurrence.
Main Results:
- Generalized seizures were more frequent during wakefulness and daytime (p<0.001).
- Seizure occurrence at night increased with age (p=0.046).
- Frontal lobe seizures occurred more during sleep in adolescents (p<0.0001), who were 3.6 times more likely to experience them during sleep.
Conclusions:
- Seizure timing patterns suggest age-dependent alterations in circadian rhythms affecting seizure susceptibility.
- Findings may aid in predicting periods of heightened seizure risk in children.
Aim:
To identify factors that influence diurnal and sleep/wake seizure timing in children undergoing tapered drug withdrawal in an epilepsy monitoring unit.
Methods:
Medical charts of patients that underwent video-EEG were reviewed. Seizures were evaluated based on their occurrence in three-hour time intervals (bins) and between wakefulness and sleep. Patients were classified according to EEG localisation and age: infants (≤3 years), children (3-12 years), and adolescents (>12-21 years). Analysis utilising generalised estimating equations with a negative binomial distribution was performed.
Results:
A total of 390 patients (188 girls; mean age: 9.2 years; SD: 6.0) had 1,754 seizures. Generalised seizures (109 patients; 490 seizures) occurred more during wakefulness (p<0.001) and during the day (p<0.001). Modelling revealed a greater occurrence of seizures at night with increasing age (p=0.046). Temporal lobe seizures (62 patients; 271 seizures) occurred overall more frequently during wakefulness (p=0.03). Frontal lobe seizures (41 patients; 184 seizures) occurred more frequently during wakefulness in infants (p<0.05) and more frequently during sleep in adolescents (p<0.0001). Adolescents with frontal lobe seizures were 3.6 times more likely to have seizures during sleep compared to other children (95% CI: 1.8-7.2).
Conclusion:
These findings are suggestive of changes in circadian rhythmicity that may alter seizure susceptibility in different age groups. The results may assist in prediction of periods of greatest seizure propensity.
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