Circadian Rhythm Of Epileptic Seizure Of Children With Acquired Brain Injury

Objective:To explore the inner mechanism of the rhythmicity of epilepsy,we first study the circadian rhythm of epileptic seisure of children with acquired brain injury,and based on which,a comparison was made among the differences of the seizure time distribution and sleep quality between the two groups:children with brain injury before and after the establishment of the circadian rhythm.Methods:We collected the patients diagnosed as epilepsy and hospitalized in the Pediatrics Center of Zhujiang Hospital of Southern Medical University during Janurary 1,2017 to June 30,2020.After the inclusion and exclusion,60 children with acquired etiology were confirmed to be our study objects.With 2-hour block,we set 05:00(the point at which the body’s central body temperature is lowest)as the starting point and divided a whole day into 12 sessions.We also defined the day as 06:00 to 18:00 while the night as 18:00 to 06:00 of the next day.In this study,we regard 3 months after birth as the age when the basic circadian rhythm of human body have established.All the objects enrolled were divided into two groups:children with brain injury before and children with brain injury after the establishment of the circadian rhythm.We would compare the diurnal distribution and day-night distribution between the two groups.Then we gave most of the study objects(a little part of the cases fail to get contact with)a follow-up interview by telephone and asked their parents to finish a questionnaire to kown about the children’ sleep quality and seisure control in the recent 2 months.The data collected in this part were also been compared between the 2 groups.Non-parametric rank-sum test was used to analyse our data and P<0.05 was considered to be statistically significant.Results:Our study included 60 children with acquired epilepsy as the study objects with totally 386 epileptic seisures recorded by EEG.With regarding to the onset age,30 cases were ≤3 months while the other 30 cases were>3 months.In the overall analysis,60 cases had a higher seisure frequency in the day(P<0.05)and significantly more seisures were observed from 17:00 to 18:59 while from 03:00 to 04:59 significantly fewer seisures were seen.As for the group in which the onset age were ≤3 months,the day-night distribution had no statistical significance and the peak-time blocks of this group were 17:00-18:59 and 23:00-00:59(P=0.02).Seisures in the other group significantly occurred in the day(P=0.036)and peaked between 17:00-18:59.In the next step,we tried to give all the study objects a follow-up interview by telephone but a little part of the cases fail to get contact with,and eventually we successfully asked 49 parents to finish a questionnaire to learn about the children’ sleep quality and seisure control in the recent 2 months.In this part of data,24 objects recorded fell victims to brain injury before the circadian rhythm established while 25 objects after.The former’s average score of sleep disorder was 3.04 points and the latter got a lower score of 2.72 points.However,there was no statistical difference between the scores of the two groups.Then we divided the 49 cases into 3 groups and "group-a" included the cases whose seisures have been controlled,"group-b" included the cases whose seisures had effectively reduced after treament,"group-c" represented the cases without obvious change on seisure frequency than before.Among the 3 groups,group-c achieved the highest average score(n=19,3.57 points)with group-b being the second(n=22,3.14points)and group-a the lowest(n=8,0.5 points).There were statistical significance between group-a and group-b、group-a and group-c(P<0.001)but none between group-b and group-c(P=0.444).Conclusions:Seisures of children with acquired epilepsy have a strong tendancy to occurred in the day and follow a specific diurnal pattern.The rhythmicity of epileptic seisures is more obvious in children who got the brain injury after their circadian rhythm established.Children who got the brain injury after their circadian rhythm established also achieved a lower score of sleep disorder than children who fell victims to the brain injury before the establishment of the circadian rhythm,though there was no statistical significance between the two.This may be accounted for in our failure to control other relevant variations like seisure control.