Circadian rhythm and epilepsy

Advances in diagnostic technology, including chronic intracranial EEG recordings, have confirmed the clinical observation of different temporal patterns of epileptic activity and seizure occurrence over a 24-h period. The rhythmic patterns in epileptic activity and seizure occurrence are probably re...

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Bibliographic Details
Published in:Lancet neurology 2018-12, Vol.17 (12), p.1098-1108
Main Authors: Khan, Sofia, Nobili, Lino, Khatami, Ramin, Loddenkemper, Tobias, Cajochen, Christian, Dijk, Derk-Jan, Eriksson, Sofia H
Format: Article
Language:English
Subjects:
Animals
Antiepileptic agents
BMAL1 protein
Brain research
Circadian rhythm
Circadian Rhythm - physiology
Circadian rhythms
Convulsions & seizures
EEG
Epilepsy
Epilepsy - physiopathology
Excitability
FDA approval
Hormones
Humans
Melatonin
Neurology
Neurophysiology
Seizures
Sleep deprivation
Transcranial magnetic stimulation
Transcription factors
Vigilance
Writing
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Summary:Advances in diagnostic technology, including chronic intracranial EEG recordings, have confirmed the clinical observation of different temporal patterns of epileptic activity and seizure occurrence over a 24-h period. The rhythmic patterns in epileptic activity and seizure occurrence are probably related to vigilance states and circadian variation in excitatory and inhibitory balance. Core circadian genes BMAL1 and CLOCK, which code for transcription factors, have been shown to influence excitability and seizure threshold. Despite uncertainties about the relative contribution of vigilance states versus circadian rhythmicity, including circadian factors such as seizure timing improves sensitivity of seizure prediction algorithms in individual patients. Improved prediction of seizure occurrence opens the possibility for personalised antiepileptic drug-dosing regimens timed to particular phases of the circadian cycle to improve seizure control and to reduce side-effects and risks associated with seizures. Further studies are needed to clarify the pathways through which rhythmic patterns of epileptic activity are generated, because this might also inform future treatment options.
ISSN:1474-4422
1474-4465
DOI:10.1016/S1474-4422(18)30335-1