Bimodal ultradian seizure periodicity in human mesial temporal lobe epilepsy

Matthew Karafin; Erik K St. Louis; M. Bridget Zimmerman; Jon David Sparks; Mark A Granner

doi:10.1016/j.seizure.2010.05.005

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Bimodal ultradian seizure periodicity in human mesial temporal lobe epilepsy

Journal article

Open access

Peer reviewed

Bimodal ultradian seizure periodicity in human mesial temporal lobe epilepsy

Matthew Karafin, Erik K St. Louis, M. Bridget Zimmerman, Jon David Sparks and Mark A Granner

Seizure (London, England), Vol.19(6), pp.347-351

2010

DOI: 10.1016/j.seizure.2010.05.005

PMCID: PMC2921217

PMID: 20580271

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Abstract

Mesial temporal lobe epilepsy (mTLE) has been suggested to follow a circadian rhythm. Previous research found an afternoon peak in mTLE seizure occurrence. We evaluated the pattern of seizure occurrence in patients with well-localized mTLE and hypothesized that peak seizure frequency would occur in the afternoon, and that this pattern would not be altered by age, gender, or seizure focus. We retrospectively identified consecutive mTLE patients with a seizure-free outcome following anterior temporal lobectomy from 1993 to 2004 with video-EEG captured seizures. We recorded and plotted the 24-h clock time for each seizure and performed cosinor analysis. SAS Proc GLIMMIX was used to fit the linearized transform of the cosinor model. Negative binomial regression fitted by the generalized estimating equations (GEE) method was also performed to estimate and compare the mean seizure rates over a 24-h day. Sixty mTLE patients monitored between 2 and 16 days were analyzed. Mean (standard deviation), median number of seizures per subject were 10.47(7.86), 9.00. Cosinor plots indicated that the function had two modes: 7–8 a.m. and 4–5 p.m. GEE analysis was consistent with peak seizure frequency occurrence at 6–8 a.m. ( p < 0.0001) and 3–5 p.m. ( p < 0.01). We found a bimodal pattern of seizure occurrence in human mTLE, with peak seizure frequencies occurring between 6–8 a.m. and 3–5 p.m. confirming an afternoon peak, as well as a previously unsuspected morning peak in seizure occurrence that provides rationale for future investigations of antiepileptic drug chronopharmacology and informs patient counseling regarding patterns of seizure occurrence.

Circadian

Mesial temporal lobe

Epilepsy

Periodicity

Details

Title: Subtitle: Bimodal ultradian seizure periodicity in human mesial temporal lobe epilepsy
Creators: Matthew Karafin - Iowa Comprehensive Epilepsy Program, Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
Erik K St. Louis - Iowa Comprehensive Epilepsy Program, Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
M. Bridget Zimmerman - Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, United States
Jon David Sparks - Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, United States
Mark A Granner - Iowa Comprehensive Epilepsy Program, Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States
Resource Type: Journal article
Publication Details: Seizure (London, England), Vol.19(6), pp.347-351
Publisher: Elsevier Ltd
DOI: 10.1016/j.seizure.2010.05.005
PMID: 20580271
PMCID: PMC2921217
ISSN: 1059-1311
eISSN: 1532-2688
Language: English
Date published: 2010
Academic Unit: Neurology; Biostatistics; Neurosurgery
Record Identifier: 9983997345002771

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