Circadian Rhythm Of The Seizures Of Post-encephalitis Epilepsy In Children

Object:Based on the analysis of the clinical characteristics of post-encephalitis epilepsy in children,the circadian rhythm of epileptic seizures was studied to understand the relationship between the gender,age,the first time of epileptic seizure,seizure forms,electroencephalophysiological characteristics,imaging findings and circadian rhythm of the seizures of children with post-encephalitis epilepsy.It provides new ideas for diagnosis,treatment and prognosis of post-encephalitis epilepsy.Methods:Collection of Pediatrics Center of Zhujiang Hospital of Southern Medical University from January 1,2010 to January 1,2017,diagnosed as "viral encephalitis" and "secondary epilepsy" or "symptomatic epilepsy".There were a total of 44 children(aged 0-14).In all cases,cranial magnetic resonance imaging(MRI)and long-term dynamic video EEG were performed.The distribution of seizures in children with daytime/nighttime,sleep/wake was recorded.We will artificially define daytime hours from 06:00 to 18:00 daily,and 18:00 to 06:00 the next day as night time,as a circadian distribution of epileptic seizures.We defined daytime seizures as 80%or more of the total number of epileptic seizures at daytime,and defined nighttime seizures as 80%or more of the total number of epileptic seizures at night,and others as irregular.We will record the sleep-wake state of each epileptic seizure as a classification of the sleep-wake distribution of seizures.We define arousal seizures as 80%or more of the total number of seizures in the arousal state,80%or more of the total number of seizures in sleep state is defined as sleep seizures,and the others are defined as irregular seizures.By analyzing the relationship between epileptic seizures and various clinical data at different diurnal and different sleep/wake periods,a preliminary study was conducted on the characteristics of clinical seizures in children with post-encephalitis epilepsy.Chi-square test,continuous correction chi-square test,and Fisher's exact test were used for statistical analysis of the data,P<0.05 was statistically significant.Results:Forty-four children were included in this study,including 26(59.09%)males and 18(40.91%)females.Twenty-one patients(47.73%)with onset age of 0-3 years old(including 3 years old),10 patients(22.73%)aged 3-6 years old(including 6 years old),7 cases(15.91%)aged 6-9 years old(including 9 years old),5 cases(11.36%)aged 9-12 years old(including 12 years old),and 1 case(2.27%)aged 12-14 years old.The comprehensive origin was 21 cases(47.73%);the focal origin was 23 cases(52.27%).The tonic seizures,myoclonic seizures and epileptic spasms are the most common.There were 5 cases with normal cranial MRI examination(11.36%),and 39 cases with abnormal cranial MRI examination(88.64%).The lesions were limited to the left side with 5 cases(12.82%).The lesion range was limited to the right side.There were 0 cases,34 cases(87.18%)with bilateral lesions.Thirty-six cases(92.3%)involving the cerebral cortex and 18 cases(46.15%)involving the subcortical area.Common injuries were:temporal lobe,frontal lobe,parietal lobe,thalamus,basal ganglia,occipital lobe,hippocampus,insula.There were no significant correlations between daytime and nighttime seizures with sex differences,differences in the origin of discharge,and radiological appearance(P>0.05).The age of onset of children with daytime seizures is mostly 0-3 years old,and the age of children with nighttime seizures is more than 3 years old.In addition,daytime and arousal seizures in children were more occur at daytime,nighttime and sleep seizures were more occur at night(P<0.05),and there was no significant difference in other seizure forms between day and night(P>0.05)..Analysis of clinical features of seizures during different periods of sleep/wakefulness:In this study,there was no significant correlation between seizures at different stages of sleep/wakefulness and differences in age and radiological appearance.The gender differences in seizures in different sleep/wake periods are different.Most children with arousal type epilepsy are males,and most children with sleep-type epilepsy are females.The gender composition ratio of children with irregular seizure is similar.In addition,the tonic seizures were more common in children with sleep and irregular types.Epilepsy spasms were more common in children with arousal seizures,and there was no significant difference in the other seizures in different day-night periods.From the comparative study of the origin of the epileptiform discharges,it was found that epileptic seizures originating from the hernia region were more common in children with arousal seizures.In this study,there were 15 cases(34.09%)taking 1 antiepileptic drug,18 cases(40.91%)taking 2 antiepileptic drugs,and 11 cases taking 3 or more antiepileptic drugs.(25%).Seizures were controlled in 27 children(61.36%)after treatment.Seizures were improved in 8 children(18.18%),and 9 children(20.46%)who had arousal seizures had no improvement after treatment(P<0.05).Conclusions:The tonic seizures and epileptic spasms in children with post-encephalitis epilepsy have their own circadian rhythms.The other forms of seizures have no rhythm.There are circadian rhythm features in epileptic seizures originating in the temporal region.There was no significant relationship between lesion location and epileptic seizures.Seizures occur at different stages of sleep/wakefulness,the prognosis of children with epilepsy is different,and those who have seizures that arepredominant in arousal have a poorer prognosis.