Seizure Cycles in Focal Epilepsy: JAMA study
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The findings of a recent study in JAMA Neurology establish the high prevalence of circadian and multidien seizure cycles and reveal the existence of distinct seizure chronotypes in focal epilepsy.

Focal epilepsy is characterized by the cyclical recurrence of seizures. This study was aimed to establish the prevalence, strength, and temporal patterns of seizure cycles over timescales of hours to years.

This retrospective cohort study analyzed data from continuous intracranial electroencephalography (cEEG) and seizure diaries, with durations up to 10 years. A total of 222 adults with medically refractory focal epilepsy were selected from 256 total participants in a clinical trial of an implanted responsive neurostimulation device.

Results are;
--The prevalence of circannual (approximately 1 year) seizure cycles was 12%, the prevalence of multidien (approximately weekly to approximately monthly) seizure cycles was 60%, and the prevalence of circadian (approximately 24 hours) seizure cycles was 89%.

--Strengths of circadian and multidien seizure cycles were comparable, whereas circannual seizure cycles were weaker.

--Across individuals, circadian seizure cycles showed 5 peaks: morning, mid-afternoon, evening, early night, and late night.

--Multidien cycles of IEA showed peak periodicities centered around 7, 15, 20, and 30 days. Independent of multidien period length, self-reported and electrographic seizures consistently occurred during the days-long rising phase of multidien cycles of IEA.

In conclusion, findings establish the high prevalence of plural seizure cycles and help explain the natural variability in seizure timing. The results have the potential to inform the scheduling of diagnostic studies, the delivery of time-varying therapies, and the design of clinical trials in epilepsy.

Source: https://jamanetwork.com/journals/jamaneurology/article-abstract/2775979
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