Format

Send to

Choose Destination
Seizure. 2019 Aug;70:90-96. doi: 10.1016/j.seizure.2019.06.017. Epub 2019 Jun 18.

The onset of pediatric refractory status epilepticus is not distributed uniformly during the day.

Author information

1
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain.
2
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
3
Division of Neurology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
4
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Pediatric Neurology Unit, Department of Pediatrics, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma, Spain.
5
Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
6
Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
7
Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, VA, USA.
8
Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
9
Departments of Pediatrics and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
10
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
11
Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
12
Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
13
Division of Pediatric and Developmental Neurology, Departments of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
14
Department of Neurology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA.
15
Division of Child Neurology, Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY, USA.
16
Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, NC, USA.
17
Departments of Pediatrics and Neurology, Seattle Children's Hospital, University of Washington, and Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA.
18
Department of Neurology, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
19
Department of Neurology, Mayo Clinic, Mayo Clinic School of Medicine, Rochester, MN, USA.
20
Department of Neurology, Doernbercher Children's Hospital, Oregon Health & Science University, Portland, OR, USA.
21
Department of Neurology, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
22
Division of Critical Care Medicine, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
23
Barrow Neurological Institute, Phoenix Children's Hospital, Department of Pediatrics, University of Arizona School of Medicine, Phoenix, AZ, USA.
24
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: tobias.loddenkemper@childrens.harvard.edu.

Abstract

PURPOSE:

To evaluate whether the onset of pediatric refractory status epilepticus (rSE) is related to time of day.

METHOD:

We analyzed the time of day for the onset of rSE in this prospective observational study performed from June 2011 to May 2019 in pediatric patients (1 month to 21 years of age). We evaluated the temporal distribution of pediatric rSE utilizing a cosinor analysis. We calculated the midline estimating statistic of rhythm (MESOR) and amplitude. MESOR is the estimated mean number of rSE episodes per hour if they were evenly distributed. Amplitude is the difference between MESOR and maximum rSE episodes/hour, or between MESOR and minimum rSE episodes/hour. We also evaluated the temporal distribution of time to treatment.

RESULTS:

We analyzed 368 patients (58% males) with a median (p25 - p75) age of 4.2 (1.3-9.7) years. The MESOR was 15.3 (95% CI: 13.9-16.8) and the amplitude was 3.2 (95% CI: 1.1-5.3), p = 0.0024, demonstrating that the distribution is not uniform, but better described as varying throughout the day with a peak in the morning (11am-12 pm) and trough at night (11 pm-12 am). The duration from rSE onset to application of the first non-benzodiazepine antiseizure medication peaked during the early morning (2am-3 am) with a minimum during the afternoon (2 pm-3 pm) (p = 0.0179).

CONCLUSIONS:

The distribution of rSE onset is not uniform during the day. rSE onset shows a 24-h distribution with a peak in the mid-morning (11am-12 pm) and a trough at night (11 pm-12am).

KEYWORDS:

24-hour rhythms; Chronobiology; Epilepsy; Pediatric; Status epilepticus

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center