OBJECTIVE Cyclic phenomena in epilepsy are well recognized. We investigated a multicenter cohort of unprovoked first seizure presentations to determine whether seizures have a preponderance to occur in: a particular time of the day, a particular day of the week, a particular month of the year, day time versus night time, and wakefulness versus sleep. METHODS We retrospectively studied adults who presented with a first-ever unprovoked seizure to the First Seizure Clinic at two tertiary centers in Australia. Seizure onset time was obtained from the emergency department and ambulance documentations. Electro-clinical and neuroimaging findings were reviewed. We used histograms and Poisson regression modeling to determine whether seizures have a preponderance to occur at a particular time and calculated incidence rate ratios (IRR). We performed further analysis on patients with "first seizure epilepsy" and "first seizure not epilepsy" based on the ILAE criteria for a diagnosis of epilepsy after a single unprovoked seizure, as well as comparing patients that could be categorized as having a generalized-onset seizure versus those with focal-onset seizures. RESULTS We analyzed 1724 patients (38% females; age range 14-97 yr, median 39 yr), of whom 18% had epileptiform abnormalities on EEG and potentially epileptogenic lesions were detected on neuroimaging in 28%. Whole cohort analysis shows the incidence rate ratios (IRR) of seizures varied significantly across the 24-hour clock-time of the day (p < 0.001), peaking at hour 12 (IRR 3.18). The first unprovoked seizure was significantly less likely to be reported during the night (IRR 0.61, p < 0.001) and during sleep (IRR 0.29, p < 0.001). Both the "first seizure epilepsy" and "first seizure not epilepsy" subgroups' analysis demonstrated similar patterns. An infraradian pattern was also noted with seizures most likely to occur in May (IRR 1.29, p = 0.02). Both "first seizure epilepsy - generalized" and "first seizure epilepsy - focal" groups had a preponderance for seizures to occur during the day versus night and wakefulness as opposed to sleep, but the association was more robust for generalized seizures. CONCLUSIONS Our results suggest that temporal patterns are seen in patients with first-ever unprovoked seizures, including those that meet contemporary criteria for epilepsy. These results raise the possibility that first unprovoked seizures have intrinsic rhythmicity similar to epileptic seizures.

中文翻译：

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第一次无端癫痫发作的时间模式

目的 癫痫中的周期性现象已得到广泛认可。我们调查了一个多中心队列的无端首次癫痫发作，以确定癫痫发作是否主要发生在：一天中的特定时间、一周中的特定一天、一年中的特定月份、白天与夜晚的时间以及清醒与睡眠相比。方法 我们对澳大利亚两个三级中心的 First Seizure Clinic 首次出现无端癫痫发作的成年人进行了回顾性研究。从急诊科和救护车文件中获得癫痫发作时间。审查了电子临床和神经影像学结果。我们使用直方图和泊松回归模型来确定癫痫发作是否在特定时间优先发生并计算发生率比 (IRR)。我们根据 ILAE 诊断单次无诱因癫痫发作后癫痫的标准，对“首次发作性癫痫”和“首次发作非癫痫”患者进行了进一步分析，并比较了可归类为全身性发作的患者癫痫发作与局灶性癫痫发作相比。结果 我们分析了 1724 名患者（38% 女性；年龄范围 14-97 岁，中位年龄 39 岁），其中 18% 的 EEG 有癫痫样异常，28% 的神经影像学检测到潜在的癫痫病灶。整个队列分析显示，癫痫发作的发生率比 (IRR) 在一天的 24 小时时钟时间内变化显着（p < 0.001），在第 12 小时达到峰值（IRR 3.18）。第一次无端癫痫发作在夜间报告的可能性要小得多（IRR 0.61，p < 0. 001) 和睡眠期间 (IRR 0.29, p < 0.001)。“首次发作性癫痫”和“首次发作而非癫痫”亚组的分析显示出相似的模式。还注意到最有可能在 5 月发生癫痫发作的亚弧度模式（IRR 1.29，p = 0.02）。“首次发作性癫痫 - 全身性”和“首次发作性癫痫 - 局灶性”组的癫痫发作发生在白天与夜间和清醒（与睡眠相反）的发生率较高，但对于全身性癫痫发作的关联性更强。结论 我们的结果表明，在首次无诱因癫痫发作的患者中可以看到时间模式，包括那些符合当代癫痫标准的患者。