Why do seizures in generalized epilepsy often occur in the morning?

Abstract

Objective: We used transcranial magnetic stimulation to investigate the effect of diurnal variability on cortical excitability in patients with epilepsy. Methods: Thirty drug-naive patients with epilepsy (20 idiopathic generalized epilepsy [IGE], including 10 juvenile myoclonic epilepsy [JME], and 10 focal epilepsy) and 10 control subjects without epilepsy were studied both early in the morning and late in the afternoon. We measured the mean motor thresholds and constructed recovery curves at short (2-15 msec) and long (50400 msec) interstimulus intervals. Results: An increase in cortical excitability indicated by decreased short and long intracortical inhibition was observed early in the mo..