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).
| Original language | English (US) |
|---|---|
| Pages (from-to) | 90-96 |
| Number of pages | 7 |
| Journal | Seizure |
| Volume | 70 |
| DOIs | |
| State | Published - Aug 2019 |
Keywords
- 24-hour rhythms
- Chronobiology
- Epilepsy
- Pediatric
- Status epilepticus
ASJC Scopus subject areas
- Neurology
- Clinical Neurology
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The onset of pediatric refractory status epilepticus is not distributed uniformly during the day. / Sánchez Fernández, Iván; Gaínza-Lein, Marina; Abend, Nicholas S.; Amengual-Gual, Marta; Anderson, Anne; Arya, Ravindra; Brenton, J. Nicholas; Carpenter, Jessica L.; Chapman, Kevin E.; Clark, Justice; Farias-Moeller, Raquel; Davis Gaillard, William; Glauser, Tracy A.; Goldstein, Joshua; Goodkin, Howard P.; Guerriero, Réjean M.; Hecox, Kurt; Jackson, Michele; Kapur, Kush; Kelley, Sarah A.; Kossoff, Eric H.W.; Lai, Yi Chen; McDonough, Tiffani L.; Mikati, Mohamad A.; Morgan, Lindsey A.; Novotny, Edward J.; Ostendorf, Adam P.; Payne, Eric T.; Peariso, Katrina; Piantino, Juan; Riviello, James J.; Sannagowdara, Kumar; Stafstrom, Carl E.; Tasker, Robert C.; Tchapyjnikov, Dmitry; Topjian, Alexis A.; Vasquez, Alejandra; Wainwright, Mark S.; Wilfong, Angus; Williams, Korwyn; Loddenkemper, Tobias.
In: Seizure, Vol. 70, 08.2019, p. 90-96.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - The onset of pediatric refractory status epilepticus is not distributed uniformly during the day
AU - Sánchez Fernández, Iván
AU - Gaínza-Lein, Marina
AU - Abend, Nicholas S.
AU - Amengual-Gual, Marta
AU - Anderson, Anne
AU - Arya, Ravindra
AU - Brenton, J. Nicholas
AU - Carpenter, Jessica L.
AU - Chapman, Kevin E.
AU - Clark, Justice
AU - Farias-Moeller, Raquel
AU - Davis Gaillard, William
AU - Glauser, Tracy A.
AU - Goldstein, Joshua
AU - Goodkin, Howard P.
AU - Guerriero, Réjean M.
AU - Hecox, Kurt
AU - Jackson, Michele
AU - Kapur, Kush
AU - Kelley, Sarah A.
AU - Kossoff, Eric H.W.
AU - Lai, Yi Chen
AU - McDonough, Tiffani L.
AU - Mikati, Mohamad A.
AU - Morgan, Lindsey A.
AU - Novotny, Edward J.
AU - Ostendorf, Adam P.
AU - Payne, Eric T.
AU - Peariso, Katrina
AU - Piantino, Juan
AU - Riviello, James J.
AU - Sannagowdara, Kumar
AU - Stafstrom, Carl E.
AU - Tasker, Robert C.
AU - Tchapyjnikov, Dmitry
AU - Topjian, Alexis A.
AU - Vasquez, Alejandra
AU - Wainwright, Mark S.
AU - Wilfong, Angus
AU - Williams, Korwyn
AU - Loddenkemper, Tobias
N1 - Funding Information: ISF is funded by the Epilepsy Research Fund and was funded by Fundación Alfonso Martín Escudero and the HHV6 Foundation. MG-L reports no disclosures. NSA reports no disclosures. MA-G is funded by a grant for the study of status epilepticus from “Fundación Alfonso Martín Escudero”. AA reports no disclosures. RA reports no disclosures. JNB reports no disclosures. JLC reports no disclosures. KEC reports no disclosures. JC reports no disclosures. RF-M reports no disclosures. WDG is an editor for Epilepsy Research. TAG is funded by NIH grants 2U01-NS045911, U10-NS077311, R01-NS053998, R01-NS062756, R01-NS043209, R01-LM011124, and R01-NS065840. He has received consulting fees from Supernus, Sunovion, Eisai, and UCB. He also serves as an expert consultant for the US Department of Justice and has received compensation for work as an expert on medico-legal cases. He receives royalties from a patent license. JLG reports no disclosures. HPG reports no disclosures. RMG reports no disclosures. KH reports no disclosures. MCJ reports no disclosures. KK reports no disclosures. SAK reports no disclosures. EHWK reports no disclosures. YCL reports no disclosures. TLM reports no disclosures. MAM reports no disclosures. LM reports no disclosures. EJN reports no disclosures. APO reports no disclosures. ETP reports no disclosures. KP reports no disclosures. JP reports no disclosures. JJR is a member of a data safety monitoring board for GW Pharmaceuticals. His spouse is an editor for Uptodate. KS reports no disclosures. CES has received consultant fees from Mallinckrodt and speaker fees from Nutricia. RCT reports no disclosures. DT reports no disclosures. AAT reports no disclosures. AV reports no disclosures. MSW serves as a scientific consultant and on the clinical advisory board for Sage Therapeutics. AW receives research funding from Novartis, Eisai, Pfizer, UCB, Acorda, Lundbeck, GW Pharma, Upsher-Smith, and Zogenix and receives publication royalties from Uptodate. KW reports no disclosures. TL serves on the Council (and as President) of the American Clinical Neurophysiology Society (active), on the American Board of Clinical Neurophysiology (active), served as an Associate Editor for Seizure, served on the Laboratory Accreditation Board for Long Term (Epilepsy and Intensive Care Unit) Monitoring, and serves as an Associate Editor for Wyllie’s Treatment of Epilepsy 6th and 7th edition. He is part of patent applications and license agreements to detect and predict seizures, and to manage and diagnose epilepsy, and future revenue from these scientific contributions cannot be ruled out. TL is co-inventor of the TriVox Health technology. TL and Boston Children’s Hospital might receive financial benefits in the form of compensation in the future. He received research support from the NIH, Epilepsy Research Fund, the Epilepsy Foundation of America, the Epilepsy Therapy Project, the Pediatric Epilepsy Research Foundation, Lundbeck, Eisai, Upsher-Smith, Sunovion, Mallinckrodt, Empatica, Sage, and Pfizer. He served as a consultant for Zogenix, Upsher Smith, Amzell, Sunovion, Engage, UCB, Advance Medical, and Grand Rounds. He performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies at Boston Children's Hospital and affiliated hospitals and bills for these procedures and he evaluates pediatric neurology patients and bills for clinical care. He has received speaker honorariums from national societies including the AAN, AES and ACNS, and for grand rounds at various academic centers. His wife, Dr. Karen Stannard, is a pediatric neurologist and she performs video electroencephalogram long-term and ICU monitoring, electroencephalograms, and other electrophysiological studies and bills for these procedures and she evaluates pediatric neurology patients and bills for clinical care. Funding Information: This study and consortium was funded by the Epilepsy Foundation of America ( EF-213583 , Targeted Initiative for Health Outcomes), by American Epilepsy Society/Epilepsy Foundation of America Infrastructure Awards , the Pediatric Epilepsy Research Foundation , and the Epilepsy Research Fund . Publisher Copyright: © 2019 British Epilepsy Association Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/8
Y1 - 2019/8
N2 - 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).
AB - 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).
KW - 24-hour rhythms
KW - Chronobiology
KW - Epilepsy
KW - Pediatric
KW - Status epilepticus
UR - http://www.scopus.com/inward/record.url?scp=85068939645&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068939645&partnerID=8YFLogxK
U2 - 10.1016/j.seizure.2019.06.017
DO - 10.1016/j.seizure.2019.06.017
M3 - Article
C2 - 31323566
AN - SCOPUS:85068939645
VL - 70
SP - 90
EP - 96
JO - Seizure : the journal of the British Epilepsy Association
JF - Seizure : the journal of the British Epilepsy Association
SN - 1059-1311
ER -