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Najar LL, Santos RP, Foldvary-Schaefer N, da Mota Gomes M. Chronotype variability in epilepsy and clinical significance: scoping review. Epilepsy Behav 2024; 157:109872. [PMID: 38870866 DOI: 10.1016/j.yebeh.2024.109872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Chronotype, which captures a person's daily preferences for activity and sleep, is still a poorly researched area in epilepsy research. Finding common chronotype characteristics in people with epilepsy (PWE) and explaining possible effects on seizure management are the main goals. METHODS Eleven large-scale investigations from 2010 to 2023 were examined in this scoping review. These studies included 1.167 PWE and 4.657 control subjects. RESULTS PWE had intermediate chronotypes more often than not. Adult patients were more morning-oriented overall, while pediatric cohorts were variable. Relationships between chronotype and seizure control were limited since only two studies in adults reported this and those results conflicted. An evening-type chronotype was found to be more common in generalized epilepsy than focal. The relationship of chronotype and specific antiseizure medication (ASM) therapy was not investigated. CONCLUSIONS The majority of PWE displayed an intermediate chronotype, but analyses based on age showed more nuanced trends, with children displaying variable patterns, adults generally tending toward morningness, and generalized epilepsy being associated with eveningness. This review underscores the importance of more research on the complex connections between epilepsy outcomes and chronotype. It emphasizes the need to study larger samples of PWE with carefully documented seizure control and ASM therapy, including dose and timing of administration to better understand the role of chronotype on epilepsy outcomes.
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Affiliation(s)
- Lucas Lima Najar
- Fellow - Graduate Program in Psychiatry and Mental Health of the Institute of Psychiatry - PROPSAM-IPUB: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Roberto Pereira Santos
- Medical Resident - Service of Neurology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nancy Foldvary-Schaefer
- Professor of Neurology, Sleep Disorders and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marleide da Mota Gomes
- Professor of Neurology, Institute of Neurology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Re CJ, Batterman AI, Gerstner JR, Buono RJ, Ferraro TN. The Molecular Genetic Interaction Between Circadian Rhythms and Susceptibility to Seizures and Epilepsy. Front Neurol 2020; 11:520. [PMID: 32714261 PMCID: PMC7344275 DOI: 10.3389/fneur.2020.00520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022] Open
Abstract
Seizure patterns observed in patients with epilepsy suggest that circadian rhythms and sleep/wake mechanisms play some role in the disease. This review addresses key topics in the relationship between circadian rhythms and seizures in epilepsy. We present basic information on circadian biology, but focus on research studying the influence of both the time of day and the sleep/wake cycle as independent but related factors on the expression of seizures in epilepsy. We review studies investigating how seizures and epilepsy disrupt expression of core clock genes, and how disruption of clock mechanisms impacts seizures and the development of epilepsy. We focus on the overlap between mechanisms of circadian-associated changes in SCN neuronal excitability and mechanisms of epileptogenesis as a means of identifying key pathways and molecules that could represent new targets or strategies for epilepsy therapy. Finally, we review the concept of chronotherapy and provide a perspective regarding its application to patients with epilepsy based on their individual characteristics (i.e., being a “morning person” or a “night owl”). We conclude that better understanding of the relationship between circadian rhythms, neuronal excitability, and seizures will allow both the identification of new therapeutic targets for treating epilepsy as well as more effective treatment regimens using currently available pharmacological and non-pharmacological strategies.
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Affiliation(s)
- Christopher J Re
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Alexander I Batterman
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Jason R Gerstner
- Department of Biomedical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Russell J Buono
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Thomas N Ferraro
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
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Smyk MK, van Luijtelaar G. Circadian Rhythms and Epilepsy: A Suitable Case for Absence Epilepsy. Front Neurol 2020; 11:245. [PMID: 32411068 PMCID: PMC7198737 DOI: 10.3389/fneur.2020.00245] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Many physiological processes such as sleep, hormonal secretion, or thermoregulation, are expressed as daily rhythms orchestrated by the circadian timing system. A powerful internal clock mechanism ensures proper synchronization of vital functions within an organism on the one hand, and between the organism and the external environment on the other. Some of the pathological processes developing in the brain and body are subjected to circadian modulation as well. Epilepsy is one of the conditions which symptoms often worsen at a very specific time of a day. Variation in peak occurrence depends on the syndrome and localization of the epileptic focus. Moreover, the timing of some types of seizures is closely related to the sleep-wake cycle, one of the most prominent circadian rhythms. This review focuses on childhood absence epilepsy (CAE), a genetic generalized epilepsy syndrome, in which both, the circadian and sleep influences play a significant role in manifestation of symptoms. Human and animal studies report rhythmical occurrence of spike-wave discharges (SWDs), an EEG hallmark of CAE. The endogenous nature of the SWDs rhythm has been confirmed experimentally in a genetic animal model of the disease, rats of the WAG/Rij strain. Well-known detrimental effects of circadian misalignment were demonstrated to impact the severity of ongoing epileptic activity. SWDs are vigilance-dependent in both humans and animal models, occurring most frequently during passive behavioral states and light slow-wave sleep. The relationship with the sleep-wake cycle seems to be bidirectional, while sleep shapes the rhythm of seizures, epileptic phenotype changes sleep architecture. Circadian factors and the sleep-wake states dependency have a potential as add-ons in seizures' forecasting. Stability of the rhythm of recurrent seizures in individual patients has been already used as a variable which refines existing algorithms for seizures' prediction. On the other hand, apart from successful pharmacological approach, circadian hygiene including sufficient sleep and avoidance of internal desynchronization or sleep loss, may be beneficial for patients with epilepsy in everyday management of seizures.
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Affiliation(s)
- Magdalena K Smyk
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | - Gilles van Luijtelaar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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Viticchi G, Falsetti L, Paolucci M, Altamura C, Buratti L, Salvemini S, Brunelli N, Bartolini M, Vernieri F, Silvestrini M. Influence of chronotype on migraine characteristics. Neurol Sci 2019; 40:1841-1848. [DOI: 10.1007/s10072-019-03886-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/05/2019] [Indexed: 02/06/2023]
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Amengual-Gual M, Sánchez Fernández I, Loddenkemper T. Patterns of epileptic seizure occurrence. Brain Res 2019; 1703:3-12. [DOI: 10.1016/j.brainres.2018.02.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 12/03/2017] [Accepted: 02/20/2018] [Indexed: 01/03/2023]
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Khan S, Nobili L, Khatami R, Loddenkemper T, Cajochen C, Dijk DJ, Eriksson SH. Circadian rhythm and epilepsy. Lancet Neurol 2018; 17:1098-1108. [PMID: 30366868 DOI: 10.1016/s1474-4422(18)30335-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/18/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
Abstract
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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Affiliation(s)
- Sofia Khan
- 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
| | - Lino Nobili
- 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
| | - Ramin Khatami
- Centre for Sleep Research, Sleep Medicine and Epileptology, Klinik Barmelweid AG, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sofia H Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK.
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Bauer M, Glenn T, Monteith S, Gottlieb JF, Ritter PS, Geddes J, Whybrow PC. The potential influence of LED lighting on mental illness. World J Biol Psychiatry 2018; 19:59-73. [PMID: 29251065 DOI: 10.1080/15622975.2017.1417639] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Two recent scientific breakthroughs may alter the treatment of mental illness, as discussed in this narrative review. The first was the invention of white light-emitting diodes (LEDs), which enabled an ongoing, rapid transition to energy-efficient LEDs for lighting, and the use of LEDs to backlight digital devices. The second was the discovery of melanopsin-expressing photosensitive retinal ganglion cells, which detect environmental irradiance and mediate non-image forming (NIF) functions including circadian entrainment, melatonin secretion, alertness, sleep regulation and the pupillary light reflex. These two breakthroughs are interrelated because unlike conventional lighting, white LEDs have a dominant spectral wavelength in the blue light range, near the peak sensitivity for the melanopsin system. METHODS Pertinent articles were identified. RESULTS Blue light exposure may suppress melatonin, increase alertness, and interfere with sleep in young, healthy volunteers and in animals. Areas of concern in mental illness include the influence of blue light on sleep, other circadian-mediated symptoms, prescribed treatments that target the circadian system, measurement using digital apps and devices, and adolescent sensitivity to blue light. CONCLUSIONS While knowledge in both fields is expanding rapidly, future developments must address the potential impact of blue light on NIF functions for healthy individuals and those with mental illness.
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Affiliation(s)
- Michael Bauer
- a Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden , Dresden , Germany
| | - Tasha Glenn
- b ChronoRecord Association, Inc , Fullerton , CA , USA
| | - Scott Monteith
- c Michigan State University College of Human Medicine, Traverse City Campus , Traverse City , MI , USA
| | - John F Gottlieb
- d Department of Psychiatry , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Philipp S Ritter
- a Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden , Dresden , Germany
| | - John Geddes
- e Department of Psychiatry , University of Oxford, Warneford Hospital , Oxford , UK
| | - Peter C Whybrow
- f Department of Psychiatry and Biobehavioral Sciences , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA) , Los Angeles , CA , USA
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Manni R, Cremascoli R, De Icco R, Terzaghi M. Chronotype in patients with epilepsy: A controlled study in 60 subjects with late-onset focal epilepsy. Epilepsy Behav 2015; 50:1-6. [PMID: 26079115 DOI: 10.1016/j.yebeh.2015.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 11/18/2022]
Abstract
Studies based on self-administered questionnaires indicate that most patients with epilepsy are morning-oriented. We aimed to investigate chronotype in patients with epilepsy with late-onset focal epilepsy by combining subjective data with dim light melatonin onset (DLMO) as an objective marker of the circadian phase. Sixty adult patients (mean age 46.5±13.8; 27 males) with late-onset focal epilepsy under pharmacological treatment were prospectively studied. Subjective chronotype was determined using the Morningness-Eveningness Questionnaire (MEQ) and circadian phase through analysis of salivary melatonin secretion, considering 3pg/ml as the dim light melatonin onset (DLMO) threshold. The mean MEQ score was significantly higher in the patients with epilepsy than in the controls, and significantly, more patients had a MEQ score indicative of the morning type (50.0% vs 30.0%, p=0.02). However, no significant differences were found in mean time of DLMO (21:38±01:21 vs 21:26±01:03; p=ns), and DLMO time was in the range indicative of an intermediate chronotype in both patients and controls. Sleep onset and sleep offset phase angles were significantly shorter in the patients. Patients whose global MEQ score identified them as morning types were significantly older than those with an intermediate or evening chronotype, and they had less social jet lag. No difference in epilepsy features and treatments was found between morning-oriented and nonmorning-oriented patients. Our analyses showed that the patients with epilepsy tended to be morning-oriented and to perceive themselves as morning types, even though this was not reflected in their DLMO values which did not differ significantly from those of controls and mostly fell within the intermediate chronotype range. Several factors may considerably influence subjective chronotype. We speculate that, in patients with epilepsy, the disease itself, prompting certain lifestyle choices, including a regular sleep schedule and early bedtime, may induce morning orientation and a morning-type self-perception.
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Affiliation(s)
- Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy.
| | - Riccardo Cremascoli
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
| | - Roberto De Icco
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy
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Kendis H, Baron K, Schuele SU, Patel B, Attarian H. Chronotypes in Patients with Epilepsy: Does the Type of Epilepsy Make a Difference? Behav Neurol 2015; 2015:941354. [PMID: 26078488 PMCID: PMC4452819 DOI: 10.1155/2015/941354] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 04/30/2015] [Accepted: 05/13/2015] [Indexed: 01/12/2023] Open
Abstract
Circadian rhythms govern all biological functions. Circadian misalignment has a major impact on health. Late chronotype is a risk factor for circadian misalignment which in turn can affect the control of seizures in epilepsy patients. We compared a group of 87 confirmed epilepsy patients regardless of subtypes with age- and sex-matched healthy controls. We compared generalized epilepsy patients with localization related epilepsy patients and with healthy controls. We found that primary generalized epilepsy patients were 5 times more likely to have a late chronotype than healthy controls. We did not find any significant differences between localization related epilepsy patients and healthy controls or between the overall epilepsy cohort and healthy controls. Generalized epilepsy patients are more likely to be evening types as compared to those with focal epilepsy or subjects without epilepsy. Epilepsy patients do not experience the same age related increase in morningness as do age-matched healthy controls. This is important in regard to timing of AED, identifying and preventing sleep deprivation, and integrating chronotype evaluations and chronotherapy in comprehensive epilepsy care. Further studies, using objective phase markers or the impact of chronotherapy on seizure control, are necessary.
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Affiliation(s)
- Hallie Kendis
- Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 1111, Chicago, IL 60611, USA
| | - Kelly Baron
- Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 1111, Chicago, IL 60611, USA
| | - Stephan U. Schuele
- Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 1111, Chicago, IL 60611, USA
| | - Bhavita Patel
- Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 1111, Chicago, IL 60611, USA
| | - Hrayr Attarian
- Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Suite 1111, Chicago, IL 60611, USA
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Abstract
INTRODUCTION Oral-controlled and modified-release drug delivery systems with zero-order sustained-release kinetics have been developed and proven suitable for meeting increasingly sophisticated therapeutic needs. Nevertheless, the impact of basic chronobiology concepts on the practice of medicine is still ongoing and to address chronotherapy needs, various types of pulsatile drug delivery systems have been innovated. The purpose of this review is to highlight these innovations in the field of chronotherapy. AREAS COVERED The present review discusses in depth on recent patents and developments related to pulsatile drug delivery systems with eroding, soluble or rupturable barrier coatings, and systems with capsular structures. Besides focusing on all recent innovations, the review addresses the novelty and feasibility of all upcoming technologies being exploited considering pulsatile drug delivery systems. EXPERT OPINION There has been a growing interest in pulsatile delivery, which generally refers to the liberation of drugs following a programmable and well-defined lag phase from the time of administration. From 1981 until the present date, patent publications related to pulsatile drug delivery have shown more promising systems with numerous developments in arena of drug delivery. Future development of chronotherapeutic medications requires proper assessment and integration with other emerging disciplines such as hydrogel and transdermal delivery systems. The selection of the appropriate chronopharmaceutical technology should take into considerations with the ease of manufacturing and the cost-effectiveness.
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Affiliation(s)
- Sumit S Patil
- Sainath University, Department of Pharmaceutical Sciences , Ranchi , India
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Epilepsy, antiseizure therapy, and sleep cycle parameters. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:670682. [PMID: 23997949 PMCID: PMC3749600 DOI: 10.1155/2013/670682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/04/2013] [Accepted: 07/18/2013] [Indexed: 01/16/2023]
Abstract
A reciprocal relationship exists between sleep and epilepsy. The quality of sleep is affected by the presence and frequency of seizures, type of antiepileptic therapy utilized, and coexisting primary sleep disorders. Daytime somnolence is one of the most common adverse effects of antiepileptic therapy, with specific pharmacologic agents exhibiting a unique influence on components of sleep architecture. The newer generation of antiseizure drugs demonstrates improved sleep efficiency, greater stabilization of sleep architecture, prolongation of REM sleep duration, and increased quality of life measures. The emerging field of chronoepileptology explores the relationship between seizures and circadian rhythms, aiming for targeted use of antiseizure therapies to maximize therapeutic effects and minimize the adverse events experienced by the patients.
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Abstract
Approximately one-third of patients with epilepsy continue to have seizures despite antiepileptic therapy. Many seizures occur in diurnal, sleep/wake, circadian, or even monthly patterns. The relationship between biomarkers and state changes is still being investigated, but early results suggest that some of these patterns may be related to endogenous circadian patterns whereas others may be related to wakefulness and sleep or both. Chronotherapy, the application of treatment at times of greatest seizure susceptibility, is a technique that may optimize seizure control in selected patients. It may be used in the form of differential dosing, as preparations designed to deliver sustained or pulsatile drug delivery or in the form of 'zeitgebers' that shift endogenous rhythms. Early trials in epilepsy suggest that chronopharmacology may provide improved seizure control compared with conventional treatment in some patients. The present article reviews chronopharmacology in the treatment of epilepsy as well as future treatment avenues.
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Affiliation(s)
- Sriram Ramgopal
- Division of Epilepsy and Clinical Neurophysiology, Harvard Medical School, Fegan 9, Boston, MA USA
- Department of Neurology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 USA
| | - Sigride Thome-Souza
- Division of Epilepsy and Clinical Neurophysiology, Harvard Medical School, Fegan 9, Boston, MA USA
- Department of Neurology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 USA
- Psychiatry Department of Clinics Hospital of Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Harvard Medical School, Fegan 9, Boston, MA USA
- Department of Neurology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115 USA
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