Sleep-wake distribution and circadian patterns of epileptic seizures in children.

Abstract

Epilepsy is one of the most common chronic neurologic disorders. Daily periodicity of epileptic seizures has been known for over a century. The diurnal patterns of epileptic seizures have also been observed in studies. To investigate the sleep/wake cycle, day/night, and 24-h periodicity of various seizure subtypes and seizure onset localizations in children. We analyzed the clinical seizures of 170 consecutive epilepsy patients who underwent video-electroencephalography (EEG) monitoring over the last 5 years. Semiology of the seizures was classified according to the semiological seizure classification. Origin of the seizures was defined by the onset of ictal activity on EEG. Seizures were evaluated in terms of occurrence during the day (06:00-18:00h) or night (18:00-06:00h), in wakefulness or in sleep, and within a 3-h time interval throughout 24h. A total of 909 seizures were analyzed. Auras, dialeptic, myoclonic, hypomotor, atonic seizures, and epileptic spasms occurred more frequently in wakefulness; tonic, clonic, and hypermotor seizures occurred more frequently in sleep. Auras, dialeptic, and atonic seizures and epileptic spasms occurred more often during daytime; hypermotor seizures occurred more often at night. Generalized seizures were seen most frequently in wakefulness (between 12:00 and 18:00h); frontal lobe seizures were seen at night and in sleep (between 24:00 and 03:00h); temporal lobe seizures were seen in wakefulness (between 06:00 and 09:00h and between 12:00 and 15:00h); occipital seizures were seen during daytime and in wakefulness (between 09:00 and 12:00h and between 15:00 and 18:00h, respectively); parietal seizures were seen mostly during daytime. Seizures in children occur in specific circadian patterns and in specific sleep/wake distributions depending on seizure onset location and semiology.