Circadian rhythm and epilepsy.

Khan S; Nobili L; Khatami R; Loddenkemper T; Cajochen C; Dijk DJ; Eriksson SH

doi:10.1016/S1474-4422(18)30335-1

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Journal article

Circadian rhythm and epilepsy.

Khan S Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK; Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Nobili L Centre of Sleep Medicine, Centre for Epilepsy Surgery C Munari, Niguarda Hospital, Milan, Italy; Child Neuropsychiatry Unit, IRCCS Giannina Gaslini Pediatric Institute, DINOGMI, University of Genoa, Italy.
Khatami R Centre for Sleep Research, Sleep Medicine and Epileptology, Klinik Barmelweid AG, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Loddenkemper T Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Cajochen C Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.
Dijk DJ Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Eriksson SH Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK. Electronic address: sofia.eriksson@ucl.ac.uk.

2018-10-28

Published in:

The Lancet. Neurology. - 2018

English 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.

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