Sleep/Wake and Diurnal Variations of Seizure Evolution in Pediatric Patients (P02.167)

Abstract

Objective: To investigate the relationship between clinical seizure evolution based on time of day and wakefulness/sleep in pediatric patients. Background ILAE seizure terminology permits characterization of seizure phases, such as evolution into generalized tonic-clonic seizures and other clinical presentations. This evolution may be dependent on clock time, sleep/wake status, and circadian rhythms. Design/Methods: Charts of 955 patients undergoing video-EEG monitoring for epilepsy were reviewed. Seizure evolution was characterized according to ILAE seizure terminology, EEG localization, and for timing in 3-hour blocks, during the day (6AM-6PM) or night, and in relation to sleep/wake status. Analysis was done with binomial testing, taking P values below 0.01 as significant. Results: 226 pediatric patients (107 girls, age 10.83 years 5.74) had 912 second-phase seizures. Of these, 93 patients (41 girls, age 11.69 years 5.73) had an additional 334 third-phase seizures. Evolutions into clonic seizures (28.5%), generalized tonic-clonic seizures (18.3%) and automotor seizures (13.3%) were most common. Peak times for evolutions were seen for different seizures, including clonic (6AM-9AM; p Conclusions: Diurnal and sleep/wake timing of seizure evolution varies based on clinical seizure type and localization. Our data assist in elucidating 24-hour seizure patterns, potentially providing new treatment approaches such as differential medication dosing. Disclosure: Dr. Loddenkemper has received personal compensation for activities with Eisai Inc. as a consultant. Dr. Loddenkemper has received research support from NIH/NINDS, The Epilepsy Foundation of America, CIMIT/DOD, Harvard Medical School Office of Faculty Development, and the Children9s Hospital Program for Patient Safety and Quality Improvement. Dr. Ramgopal has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Zarowski has nothing to disclose. Dr. Vendrame has nothing to disclose. Dr. Alexopoulos has received personal compensation for activities with UCB Pharma as a speaker. Dr. Wyllie has nothing to disclose. Dr. Kothare has nothing to disclose.