![]() ![]() A study has shown that 42% of seizures are diurnal, 21% are nocturnal and the remaining 37% are of the mixed type, indicating a significant difference in baseline seizure amount between the sleep and wakefulness phases. Sleep pattern and epilepsy Effects of sleep on epilepsyĬR modulates the brain function in several aspects, of which the regulation of sleep-wakefulness rhythm is the most important due to the different brain excitation-inhibition balances during sleep and wakefulness phases. In this review, we will describe the reciprocal relationship between CR and epilepsy from several aspects including the sleep effect, genetic modulation and brain biochemistry, and then discuss accurate prediction algorithms and therapeutic strategies based on the chronoepileptology of patients with epilepsy. A better understanding of the interaction between CR and epilepsy could facilitate more accurate prediction and potential therapeutic strategies. CR and epilepsy have a crosstalk in several physiological processes such as sleep-wakefulness cycle, expression of clock-related genes, hormone secretion and epileptic activities. Thus, alternative or adjunctive treatments are urgently required. Epilepsy is one of the most common neurological disorders characterized by spontaneous and recurrent seizures, with 30–40% of patients remaining refractory to current antiseizure medications (ASMs). Emerging evidence suggests that the disrupted CR leads to multiple diseases such as cancer, mood disorder, and neurogenerative diseases. Under the 24-h day-night cycle, endogenous biological rhythms are generated by a central pacemaker of the suprachiasmatic nuclei (SCN) in the hypothalamus and control various organ systems through numerous neuronal connections and hormonal factors. Before formal clinical practice, future large-scale studies are urgently needed to assist prediction and treatment of circadian seizure activities and address unsolved restrictions.Ĭircadian rhythm (CR), one of the most basic rhythms in mammalian behavioural and physiological processes, has been studied for hundred years. Optimization of the time and dose of antiseizure medications, and resynchronization of disturbed CR (by hormone therapy, light exposure, ketogenic diet, novel small molecules) would be beneficial for epileptic patients in the future. Furthermore, we discuss the precise predictive algorithms and chronotherapy strategies based on different temporal patterns of seizure occurrence for patients with epilepsy, which may offer a valuable indication for non-invasive closed-loop treatment system. The suprachiasmatic nuclei (SCN) has a rhythm of melatonin and cortisol secretion under the circadian pattern, and then these hormones can feed back into a central oscillator to affect the SCN-dependent rhythms, leading to variable but prominent influence on epilepsy. ![]() ![]() Clock genes accompanied by two feedback loops of regulation have an important role in cortical excitability and seizure occurrence, which may be involved in the mTORopathy. ![]() Sleep influences the epilepsy rhythm, and conversely, epilepsy alters the sleep rhythm through multiple pathways. Apart from the common seizure types, several specific epilepsy syndromes also have a close correlation with sleep-wakefulness patterns. Furthermore, the epilepsy type, seizure type and seizure onset zone can significantly affect the rhythms of seizure occurrence. For instance, specific distribution patterns of seizures and IED have been reported, i.e., lighter non-rapid eye movement (NREM) sleep stage (stage 2) induces seizures while deeper NREM sleep stage (stage 3) activates IEDs. It has been found that sleep-wake patterns, circadian timing systems and multidien rhythms have essential roles in seizure activities and interictal epileptiform discharge (IED). In this review, we present the reciprocal relationship between CR and epileptic activities from aspects of sleep effect, genetic modulation and brain biochemistry. An adequate understanding of how circadian system and epilepsy interact with each other could contribute to more accurate seizure prediction as well as rapid development of potential treatment timed to specific phases of CR. Evidence about the interaction between circadian rhythms (CR) and epilepsy has been expanded with the application of advanced detection technology. ![]()
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