Predicting diurnal and sleep/wake seizure patterns in paediatric patients of different ages

Abstract

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.

Insufficient Sleep, Electroencephalogram Activation, and Seizure Risk: Re‐Evaluating the Evidence

“…Many studies also reported an association between the circadian rhythm and seizure risk in patients with epilepsy . They have found that drowsiness and non‐rapid eye movement (NREM) sleep seem to be the states most closely associated with seizure risk, both clinically and electrographically .…”

Circadian Rhythms and Epilepsy: A Suitable Case for Absence Epilepsy

“…Interestingly, this relationship changes with age. In infants, frontal lobe seizures are more prevalent during wakefulness, whereas in adolescents, they are more frequent during sleep (57). Generalized seizures were reported to occur predominantly during wakefulness (46,47,58).…”

Can absence seizures be predicted by vigilance states?: Advanced analysis of sleep–wake states and spike–wave discharges' occurrence in rats

“…This principle is applied when seizure provocation techniques are used to facilitate the diagnosis, and sleep deprivation, a major factor precipitating seizures, is commonly used as a diagnostic tool [11,12]. Other examples of factors that influence the presence and timing of seizures are age of the patients and the localization of the focus, both appeared to be good predictors for the occurrence of epileptic discharges [13]. The main goal of epilepsy management is complete seizure control, and given that pharmacological treatment is ineffective in about 30% of patients, novel approaches based on seizures prediction are currently developed [14,15].…”