Different as night and day: Patterns of isolated seizures, clusters, and status epilepticus

Summary Using approximations based on presumed U.S. time zones, we characterized day and nighttime seizure patterns in a patient‐reported database, Seizure Tracker. A total of 632 995 seizures (9698 patients) were classified into 4 categories: isolated seizure event ( ISE ), cluster without status epilepticus ( CWOS ), cluster including status epilepticus ( CIS ), and status epilepticus ( SE ). We used a multinomial mixed‐effects logistic regression model to calculate odds ratios ( OR s) to determine night/day ratios for the difference between seizure patterns: ISE versus SE , ISE versus CWOS , ISE versus CIS , and CWOS versus CIS . Ranges of OR values were reported across cluster definitions. In adults, ISE was more likely at night compared to CWOS ( OR  = 1.49, 95% adjusted confidence interval [ CI ] = 1.36‐1.63) and to CIS ( OR  = 1.61, 95% adjusted CI = 1.34‐1.88). The OR s for ISE versus SE and CWOS versus SE were not significantly different regardless of cluster definition. In children, ISE was less likely at night compared to SE ( OR  = 0.85, 95% adjusted CI = 0.79‐0.91). ISE was more likely at night compared to CWOS ( OR  = 1.35, 95% adjusted CI = 1.26‐1.44) and CIS ( OR  = 1.65, 95% adjusted CI = 1.44‐1.86). CWOS was more likely during the night compared to CIS ( OR  = 1.22, 95% adjusted CI = 1.05‐1.39). With the exception of SE in children, our data suggest that more severe patterns favor daytime. This suggests distinct day/night preferences for different seizure patterns in children and adults.