A recent study published in The Lancet has uncovered a deeper link between circadian rhythm and the frequency of seizures in epilepsy patients.
Such knowledge of the frequency and distribution of seizures could prove invaluable in providing treatment to those suffering from epilepsy. More accurate timetables could be provided to encourage patients take medications at opportune times. In many cases, a deeper knowledge of when seizures may occur could save the lives of those who suffer with severe epilepsy.
India is lagging behind with epilepsy treatment
However, in India the benefit of such research may be limited in the current state of the healthcare system. A study published in 2012 found that nearly 95 percent of people with epilepsy in India don’t receive any treatment for epilepsy at all. That study, also published in The Lancet, recommended that epilepsy be treated with as much attention as is currently given to other noncommunicable diseases such as heart disease.
Of the seventy million people suffering from epilepsy worldwide, nearly twelve million are expected to reside in India. This represents nearly one-sixth of the global burden. Notably, the disease was found to be more common among males, lower socio-economic background individuals and in rural areas.
The fact that the most common group suffering from epilepsy are low income rural individuals may — at least in part — explain the staggeringly low rate of treatment. This group is notably underserved by the health system as healthcare infrastructure is often lacking in rural locations. Low income would likely mean a reliance on the public health system which is lacking in rural areas.
The results of the study
The timing of seizures may be linked to natural rhythms in around eighty percent of people with epilepsy claims the study. The results were derived from the largest study to date of individual patients’ seizure cycles including more than 1,000 people.
The study acknowledges that the link between epileptic seizures and other natural cycles has been studied for hundreds of years. Some now-disproven historical hypotheses suggested a link between the phases of the moon and seizure rates. While the moon plays no observable role in seizure cycles, the study has found that cycles may be over a 24-hour period, a week, or even a month. Some cycles were found to coexist.
The 24-hour cycle, or the circadian rhythm, was found to be the predominant cycle that determined seizure rates. Circadian rhythm refers to the chemical and hormonal changes that occur in every cell of the body over the course of a day. A long list of disorders and diseases have recently been found to interact with the circadian rhythm, either being affected by it or disrupting it.
“Understanding the cyclic nature of diseases is vital for treating diseases like epilepsy that continuously fluctuate in their severity,” says the study’s senior author Professor Mark Cook, based at the University of Melbourne, Australia. “The human body is a collection of thousands of clocks, each cycling in accordance with their own pacemaker. For example, some cells can track time with millisecond accuracy, while hormonal cycles might have longer periods of hours, days or more. Combined in the body, the presence of all of these cycles has a fundamental effect on our health.”
Between eight and ninety percent of those surveyed (based on the surveillance technique utilised) showed seizures that corresponded with their circadian rhythm. Two thirds of these individuals had more than one cycle associated with the seizures.
The authors say that the weekly cycle in seizures is particularly interesting, as the physiological cause of a weekly cycle is not as well established as a circadian rhythm.
The discovery of weekly cycles may have further implications. As a weekly cycle currently has no known basis in biological function, there may be other factors at play that relate to behaviour. The working week and the stress related to this may be a potential causative factor, as stress is already a known risk factor for seizures.
Can the study offer a route to improving the way in which India treats those with epilepsy?
Currently, India’s ability to cater for the needs of epileptic individuals falls far short of what is needed. However, if the healthcare system utilised the results of studies such as this it could establish the most effective means of addressing the issue.
For India to do so, long-term projects regarding infrastructure would be vital, as it is those in sparsely covered rural areas that are missing out on healthcare the most. In the short term, guidance as to where and when medical resources are needed are vital.
As the study indicates, the likeliness of seizures is predominantly dependent on the time of day. As such, government information campaigns could better inform the population of when seizures could happen, and therefore when medications are needed most. In addition, if more of the population is informed of the nature of epilepsy, people may be better equipped to help if a person they know has a seizure.