Sleep and seizure timing: ultradian, circadian, and multidien rhythms

Sleep and epilepsy have long been known to have a reciprocal relationship. Research in recent years has uncovered several important mechanisms by which sleep influences seizure frequency and severity, both in adults and children. Sanjeev Kothare, MD, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, shares an overview of the ways in which sleep affects seizures, including genetics, cycles, and glymphatics. Numerous biological cycles have been shown to influence seizures, including ultradian rhythms, circadian rhythms, multidien rhythms, and circannual cycles. For this reason, it can be important to use differential dosing based on when seizures typically occur throughout the day. Additionally, the cyclical patterns can be used as the basis of predictive modelling, in order to forecast seizure occurrence. Continuing to uncover the important pathways in the interaction between sleep and epilepsy may help advance our understanding of disease pathophysiology, as well as develop new treatment strategies and reduce medication side effects. This interview took place at the 14th European Epilepsy Congress (EEC) 2022 in Geneva, Switzerland.