title: Predicting diurnal and sleep/wake seizure patterns in paediatric patients of different ages.
abstract: OBJECTIVE
  To identify factors that influence diurnal and sleep/wake seizure timing in children undergoing tapered drug withdrawal in an epilepsy monitoring unit.
  
  
  METHODS
  Medical charts of patients that underwent video-EEG were reviewed. Seizures were evaluated based on their occurrence in three-hour time intervals (bins) and between wakefulness and sleep. Patients were classified according to EEG localisation and age: infants (≤3 years), children (3-12 years), and adolescents (>12-21 years). Analysis utilising generalised estimating equations with a negative binomial distribution was performed.
  
  
  RESULTS
  A total of 390 patients (188 girls; mean age: 9.2 years; SD: 6.0) had 1,754 seizures. Generalised seizures (109 patients; 490 seizures) occurred more during wakefulness (p<0.001) and during the day (p<0.001). Modelling revealed a greater occurrence of seizures at night with increasing age (p=0.046). Temporal lobe seizures (62 patients; 271 seizures) occurred overall more frequently during wakefulness (p=0.03). Frontal lobe seizures (41 patients; 184 seizures) occurred more frequently during wakefulness in infants (p<0.05) and more frequently during sleep in adolescents (p<0.0001). Adolescents with frontal lobe seizures were 3.6 times more likely to have seizures during sleep compared to other children (95% CI: 1.8-7.2).
  
  
  CONCLUSIONS
  These findings are suggestive of changes in circadian rhythmicity that may alter seizure susceptibility in different age groups. The results may assist in prediction of periods of greatest seizure propensity.
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, Department of Pediatrics, The Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Ramgopal
authors.affiliation: Clinical Research Program, Boston Children's Hospital, Boston, MA.
authors.forename: Christine
authors.initials: C
authors.lastname: Powell
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, Polysomnography and Sleep Research Unit, Department of Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Zarowski
authors.affiliation: Epilepsy Center, Neuroscience Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Andreas V
authors.initials: AV
authors.lastname: Alexopoulos
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA.
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Kothare
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D006801:Humans; D008297:Male; D012640:Seizures / Q000503:physiopathology*; D012890:Sleep / Q000502:physiology*; D014851:Wakefulness / Q000502:physiology*; D055815:Young Adult
keywords: circadian pattern; diurnal pattern; long-term monitoring; seizure prediction; semiology; video-EEG