Circadian rhythm and epilepsy. Issue 12 (December 2018)

• Record Type: Journal Article
• Authors: Khan, Sofia; Nobili, Lino; Khatami, Ramin; Loddenkemper, Tobias; Cajochen, Christian; Dijk, Derk-Jan; Eriksson, Sofia H
• Is Part Of: Lancet neurology. Volume 17:Issue 12(2018)
• Page Start: 1098
• Page End: 1108
• Publication Date: 2018-12
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Nervous System Diseases -- Periodicals; Neurologie -- Périodiques; Neurology; Electronic journals; Periodicals; 616.805
• DOI: 10.1016/S1474-4422(18)30335-1
• Languages: English
• ISSNs: 1474-4422

Abstract

Summary: 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.