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The onset of pediatric refractory status epilepticus is not distributed uniformly during the day

Iván Sánchez Fernández1, Marina Gaínza-Lein2, Nicholas S Abend3

  • 1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain.

Seizure
|July 20, 2019
PubMed

Insights

Pediatric refractory status epilepticus (rSE) shows a distinct daily pattern, with onset peaking in the mid-morning and lowest incidence at night. This finding suggests a circadian influence on rSE occurrence in children.

Area of Science:

  • Pediatric Neurology
  • Circadian Biology
  • Epileptology

Background:

  • Refractory status epilepticus (rSE) is a neurological emergency in children.
  • Understanding the temporal patterns of rSE onset may reveal underlying pathophysiological mechanisms.
  • Previous studies have not conclusively determined if rSE onset exhibits a diurnal variation.

Purpose of the Study:

  • To investigate the temporal distribution of pediatric refractory status epilepticus (rSE) onset.
  • To determine if rSE onset is associated with specific times of day.

Main Methods:

  • Prospective observational study of pediatric patients (1 month to 21 years) with rSE from June 2011 to May 2019.
  • Temporal distribution of rSE onset analyzed using cosinor analysis to determine rhythmicity.
  • Midline estimating statistic of rhythm (MESOR) and amplitude were calculated to describe the temporal pattern.

Main Results:

  • Analysis of 368 pediatric patients revealed a non-uniform distribution of rSE onset throughout the day.
  • Cosinor analysis demonstrated a significant circadian rhythm (p = 0.0024) with a peak incidence in the mid-morning (11 AM-12 PM) and a trough at night (11 PM-12 AM).
  • Time from rSE onset to first non-benzodiazepine antiseizure medication was longest in the early morning (2 AM-3 AM) and shortest in the afternoon (2 PM-3 PM).

Conclusions:

  • Pediatric refractory status epilepticus (rSE) onset does not occur uniformly throughout the 24-hour day.
  • A significant circadian rhythm influences rSE onset, with a peak in mid-morning and a nadir at night.
  • The timing of treatment initiation also varies diurnally, suggesting potential implications for management strategies.
Abstract

Keywords:
24-hour rhythmsChronobiologyEpilepsyPediatricStatus epilepticus

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