Circadian Rhythm Of Generalized Tonic-clonic Evolutions And Epileptic Spasms In Children

Objective:To explore the diurnal and sleep/wake patterns of epileptic spasms and generalized tonic-clonic evolutions in Chinese pediatric epilepsy patients and the peak hours during continuous 24 hours which benefit to understand the circadian patterns of epileptic spasms and generalized tonic-clonic evolutions.The research on the circadian rhythm of seizures provides a new idea for the control of seizures and the treatment of epilepsy.Methods:We correct patients with epilepsy undergoing video-electroencephalography(EEG)monitoring over one year period were reviewed for presence of epileptic spasms and generalized tonic-clonic evolutions,to analyze for their occurrence during the day(6 a.m.to 6 p.m.)or night,out of wake or sleep,and in 3-h time-blocks throughout the day.Exact epileptic spasm and generalized tonic-clonic evolutions time,the presence or absence of magnetic resonance imaging lesion was also recorded.Statistical analysis of seizure occurrence in time bins was carried out using nonparametric test.P-values<0.05,0.01,0.001 were taken as significant.Results:We analyzed 51 generalized tonic-clonic evolutions in 20 patients(17 boys,mean age 4.12).Generalized tonic-clonic evolutions occurred predominantly during sleep(p<0.05).Generalized tonic-clonic evolutions occurred most frequently between 12 a.m.and 3 p.m(p<0.05)and between 0 a.m.and 3 a.m.(p<0.05).As well,Generalized tonic-clonic evolutions occurred predominantly between 12 a.m.and 3 p.m(p<0.05)and between 0 a.m.and 3 a.m.(p<0.05)in sleep.However,there were no peak hours in wakefulness(p>0.05).Patients with magnetic resonance imaging lesions had most seizures during sleep(p<0.05).But patients without magnetic resonance imaging lesions had no difference in seizure frequency during sleep and wakefulness.Also,we analyzed 131 clusters of epileptic spasms in 23 patients(14 boys;mean age 1.53years).Epileptic spasms occurred predominantly during wakefulness(p<0.01)and during daytime(p<0.001).Epileptic spasms occurred most frequently between 9 a.m.and 12a.m(p<0.001),6 a.m.and 9a.m(p<0.001)and between 3 p.m.and 6 p.m.(p<0.001).Most epileptic spasms with generalized EEG pattems,which occurred predominantly during wakefulness(p<0.01)and during daytime(p<0.001).Patients with magnetic resonance imaging lesions had most seizures during wakefulness(p<0.001)and during daytime(p<0.001),whose occurred most frequently between 6 a.m.to noon(p<0.001).Patients with or without epileptic syndrome occurred predominantly during wakefulness(p<0.05)and during daytime(p<0.05).But epileptic spasms occurred most frequently between 9a.m.and 12a.m(p<0.05)and between 3 p.m.and 6 p.m.(p<0.05)in patients with epileptic syndrome.While epileptic spasms occurred most frequently between 6 a.m.to noon(p<0.01)in patients without epileptic syndrome.Conclusions:There were individual circadian seizure periodicity of children with epileptic spasms or generalized tonic-clonic evolutions.The study on the circadian rhythm of seizures provides a new idea for the research of epilepsy,besides further research on the mechanisms are needed.