Biological rhythms and epilepsy treatment

Abstract

Approximately one-third of patients with epilepsy are drug-refractory, necessitating novel treatment approaches. Chronopharmacology, which adjusts pharmacological treatment to physiological variations in seizure susceptibility and drug responsiveness, offers a promising strategy to enhance efficacy and tolerance. This narrative review provides an overview of the biological foundations for rhythms in seizure activity, clinical implications of seizure patterns through case reports, and the potential of chronopharmacological strategies to improve treatment. Biological rhythms, including circadian and infradian rhythms, play an important role in epilepsy. Understanding seizure patterns may help individualize treatment decisions and optimize therapeutic outcomes. Altering drug concentrations based on seizure risk periods, adjusting administration times, and exploring hormone therapy are potential strategies. Large-scale randomized controlled trials are needed to evaluate the efficacy and safety of differential and intermittent treatment approaches. By tailoring treatment to individual seizure patterns and pharmacological properties, chronopharmacology offers a personalized approach to improve outcomes in patients with epilepsy.

Keywords: biological rhythms; chronopharmacology; chronotherapy; epilepsy treatment; personalized medicine; seizure patterns.

Figure 1

Cross-correlogram illustrating the relationship between the menstrual cycle and seizure occurrence in patient 3. The cross-correlation coefficient will range from −1 to +1. A cross-correlation coefficient of +1 means that the sets are identical with a complete overlap, i.e., 100% likelihood of seizures on that exact day. Day 0 is defined as the first day in the menstrual cycle. Note the monthly peaks, indicating a robust correlation between seizures and menstruation [Reproduced with permission from Taubøll et al. (20)].