title: Use of an online epilepsy diary to characterize repetitive seizures.
abstract: CONCLUSIONS
  Little is known about patterns of seizures that occur multiple times a day, sometimes called clusters or serial seizures.
  
  
  OBJECTIVE
  The online diary, My Epilepsy Diary (MED), provided self-reported data from community-based patients to describe the characteristics of clusters.
  
  
  METHODS
  We used MED data to define a population of 5098 community outpatients, including 1177 who specified time of multiple seizures in a 24-hour period. Outcomes included cluster prevalence and frequency, distribution of interseizure time intervals, as well as the types of triggers commonly reported.
  
  
  RESULTS
  One-fourth of days with any seizures included clusters for these patients. Most days with clusters included 2 seizures, with >5 events occurring in only 10% of days. One-third of seizures occurred within 3h of the initial event and two-thirds within 6h. When more than 2 seizures occurred, the time to the next seizure decreased from an average of over 2h (to the 3rd event) to a quarter-hour (from the 4th to the 5th event).
  
  
  CONCLUSIONS
  My Epilepsy Diary data have provided the first overview of cluster seizures in a large community-based population. Treatments with less than 3-hour duration of action would be bioavailable at the time of only one-third of subsequent seizures. Although limited by the self-reported and observational nature of the diary data, some general patterns emerge and can help to focus questions for future studies.
authors.affiliation: Stanford Department of Neurology and Neurological Sciences, USA. Electronic address: robert.fisher@stanford.edu.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Fisher
authors.affiliation: Irody Inc., Boston, MA, USA. Electronic address: eyal@irody.com.
authors.forename: Eyal
authors.initials: E
authors.lastname: Bartfeld
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA; Consulting, Houston, TX, USA. Electronic address: joyce.cramer@gmail.com.
authors.forename: Joyce A
authors.initials: JA
authors.lastname: Cramer
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009862:Online Systems; D012640:Seizures / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Clusters; Diaries; Epilepsy; Patient-reported outcomes; Seizures; Serial seizures