| Objective:Based on the analysis of clinical characteristics of refractory epilepsy(RE)in children,the circadian rhythm characteristics of epileptic seizures were studied to understand the relationship between the first time of epileptic seizure,etiology,seizure forms and circadian rhythm of seizures in children with RE.It provides new ideas for early identification of high-risk children,early formulation of individualized treatment plan,prevention of RE in children and improvement of prognosis.Methods:Clinical data and seizure time of 61 children with RE who met the inclusion criteria and were admitted to the Department of Pediatric Neurology,from Pediatric Center,of Zhujiang Hospital of Southern Medical University from January 1,2019 to June 30,2022 were collected.The 24 hours were divided into day/night and 12 time periods to record and analyze the distribution of day/night and time period of epilepsy in children with RE.To analyze the relationship between the day-night distribution of seizures and the first time of epileptic seizure,we defined patients with ≥80%of seizures occurring during the day as daytime type,patients with ≥80%of seizures occurring at night as nighttime type,and the remaining patients as irregular type.We will make a descriptive analysis of the clinical characteristics of the children,and classify them according to the etiology and seizure form,so as to study the circadian rhythm characteristics of seizures in children with RE.Results:1.A total of 61 children with RE were included in this study,with 478 epileptic seizures,with a male to female ratio of 1.90:1.The median age of onset(P25,P75)was 1.5 years(0.5 years,4.5 years).39.3%of them was onset ≤1 year of age.2.Among 61 children with RE,structural etiology,genetic etiology,infectious etiology,immune etiology,metabolic etiology and unknown causes respectively accounted for 24.6%,19.7%,14.7%,3.3%,0.0%and 37.7%.39.3%of the children had abnormal perinatal history;13.1%of them had abnormal family history;6.6%had a history of febrile seizures;59.0%had abnormal physical examination of nervous system;80.3%had abnormal growth and development;52.4%had≥2 types of seizure form;54.1%had ≥10 seizures before treatment;45.9%had status epilepticus;60.7%have used more than 3 types of ASMs;72.1%had poor efficacy to first ASMs;86.8%EEG indicated bilateral discharge;60.7%had abnormal MRI.3.Most of the children whose first epileptic seizure occurred in the daytime were daytime type,while most of the children whose first epileptic seizure occurred in the night time were nighttime type(P<0.05).The children with structural etiology had more seizures during the day,the children with genetic etiology had more seizures at night(P<0.05),and the children with other causes had no obvious circadian rhythm(P>0.05).There was no significant difference in the distribution of seizures in different time periods among children with different etiology(P>0.05).According to the classification of seizure form,epileptic spasms occurred more frequently in the day,the seizure peak time was 13:00-14:59,the secondary peak times were 09:00-10:59 and 11:00-12:59,absence seizures were more frequent in the night,the seizure peak and the secondary peak time were 17:00-18:59 and 21:00-22:59.Myoclonic seizures were more frequent in day(P<0.05).There was no significant difference in the distribution of myoclonic seizures in different time periods(P>0.05).Since the number of atonic seizures was less than 1,statistical analysis of the diurnal rhythm could not be performed.No obvious circadian rhythm characteristics were observed in other forms of seizures(P>0.05).Conclusions:Children with RE have early onset age,often accompanied by or secondary abnormal growth and development,have frequent seizures in the early stages of the disease,easy to appear status epilepticus,often have multiple forms of seizures,have poor efficacy to first ASMs,have high abnormal rate of electroencephalogram and many abnormal changes in magnetic resonance.Children with RE of structural etiology and genetic etiology have day-night rhythm characteristics in their seizures.The epileptic spasm,absence and myoclonic seizures in children with RE had their own circadian rhythm characteristics. |
PDF Full Text Request