Many of the epilepsy syndromes have their seizures linked to circadian rhythm like Infantile spasms, Benign rolandic epilepsy, Juvenile myoclonic epilepsy?
What happens in the body physiology particularly in the first 30 to 180 minutes upon awakening that lead to increase cortical excitability and hence the seizure occurrence?
Is it hormonal like the cortisol awakening response ?
Versions can be different, but the circadian rhythm regulates not only the release of cortisol in the body, but also the "puffiness" of all cells of the body the first 30 -180 minutes after waking up.
There is a chance this morning a significant effect of night accumulation of cortisol than its emissions in the moment of awakening. Try to inhibit the release of anti-catabolic cortisol and evaluate this diagnosis.
The idiopathic generalised epilepsies are closely linked to abnormalities in rostromedial thalamic nuclei, projecting mainly to the frontal lobes, thus explaining the frontal preponderance of poly-spike-waves in JME. It seems likely, that a relation with the ARAS terminating in the medial thalamic nuclei is crucial. Interestingly, it seems to remodel the more performant times of day, with the first 2 hours being less effective that 10 to 12 in most humans.
Thanks Chaitra_Ramachandraiah
The paper was more descriptive of the Chronodependency in JME but yet it did not discuss why IEDs and seizurez do occur upon awakening !!
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