Seizure occurrence is linked to multiday cycles in diverse physiological signals
Seizure occurrence is linked to multiday cycles in diverse physiological signals
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DOI：
10.1111/epi.17607
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发表时间：
2023-04-20
期刊：
影响因子：
5.6
通讯作者：
Brinkmann, Benjamin H.
中科院分区：
文献类型：
--
作者：
Gregg, Nicholas M.;Attia, Tal Pal;Brinkmann, Benjamin H.
目的：影响癫痫发作时间的因素尚不清楚，癫痫发作的不可预测性仍然是导致残疾的主要原因。时间生物学的研究表明，周期生理现象是普遍存在的，在免疫、内分泌、代谢、神经和心血管功能中，每天和多天的周期都很明显。此外，对慢性大脑记录的研究发现，癫痫发作的风险与大脑活动的每日和多日周期有关。在这里，我们首次描述了多种生理信号、大脑活动和癫痫发作时间的周期性调节之间的关系。方法：在这项队列研究中，14名受试者接受了多模态腕戴传感器（记录心率、加速度计、皮电活动和温度）和植入反应性神经刺激系统（记录间歇癫痫样异常和电痉挛）的慢性动态监测。小波和滤波-希尔伯特光谱分析表征了大脑和可穿戴记录的昼夜节律和多日周期。循环统计评估电图发作时间和生理周期。结果：10例受试者符合纳入标准。平均记录时间为232天。7名受试者有可靠的脑电图发作检测（平均76次发作）。所有受试者的所有可穿戴设备信号都存在多日周期。在5名（体温）、4名（心率、相性皮电活动）和3名（加速度计、心率变异性、强直性皮电活动）受试者中，癫痫发作时间锁定为多天周期。值得注意的是，在心率的行为协变量回归后，7名受试者中有6名癫痫发作期锁定在剩余心率信号上。意义：癫痫发作时间与多种生理过程的日周期和多日周期有关。慢性多模态可穿戴设备记录可以在更广泛的个体时间生物学背景下定位罕见的阵发性事件，如癫痫发作。可穿戴设备可以促进对影响癫痫发作风险因素的理解，并实现个性化的时变癫痫治疗方法。
Objective: The factors that influence seizure timing are poorly understood, and seizure unpredictability remains a major cause of disability. Work in chronobiology has shown that cyclical physiological phenomena are ubiquitous, with daily and multiday cycles evident in immune, endocrine, metabolic, neurological, and cardiovascular function. Additionally, work with chronic brain recordings has identified that seizure risk is linked to daily and multiday cycles in brain activity. Here, we provide the first characterization of the relationships between the cyclical modulation of a diverse set of physiological signals, brain activity, and seizure timing.Methods: In this cohort study, 14 subjects underwent chronic ambulatory monitoring with a multimodal wrist-worn sensor (recording heart rate, accelerometry, electrodermal activity, and temperature) and an implanted responsive neurostimulation system (recording interictal epileptiform abnormalities and electrographic seizures). Wavelet and filter-Hilbert spectral analyses characterized circadian and multiday cycles in brain and wearable recordings. Circular statistics assessed electrographic seizure timing and cycles in physiology.Results: Ten subjects met inclusion criteria. The mean recording duration was 232 days. Seven subjects had reliable electroencephalographic seizure detections (mean = 76 seizures). Multiday cycles were present in all wearable device signals across all subjects. Seizure timing was phase locked to multiday cycles in five (temperature), four (heart rate, phasic electrodermal activity), and three (accelerometry, heart rate variability, tonic electrodermal activity) subjects. Notably, after regression of behavioral covariates from heart rate, six of seven subjects had seizure phase locking to the residual heart rate signal.Significance: Seizure timing is associated with daily and multiday cycles in multiple physiological processes. Chronic multimodal wearable device recordings can situate rare paroxysmal events, like seizures, within a broader chronobiology context of the individual. Wearable devices may advance the understanding of factors that influence seizure risk and enable personalized time-varying approaches to epilepsy care.