{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:56:17Z","timestamp":1786467377290,"version":"build-2736575974"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82301636"],"award-info":[{"award-number":["82301636"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471469"],"award-info":[{"award-number":["82471469"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Epilepsy manifesting as sleep\u2010related seizures (EpSRS) represents a common but heterogeneous group. This study aimed to identify distinct clinical subtypes of EpSRS and explore alterations in sleep\u2013wake seizure rhythms over the disease course.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>EpSRS is defined by seizures occurring \u226580% during sleep. We conducted a cross\u2010sectional study of 550 patients with EpSRS. Patients were classified as current EpSRS if \u226580% of their seizures occurred during sleep over the past year, or as previous EpSRS if they had a prior history of EpSRS but no longer met this 80% threshold during the past year. A two\u2010step cluster analysis was applied to the current EpSRS cohort, and disease trajectories were evaluated across both cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cluster analysis classified the current EpSRS cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009447) into two distinct subtypes. The sleep tonic\u2013clonic seizure (TCS) subtype (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009218) featured later onset (18.0\u2009years), infrequent (&lt;1 seizure\/month, 73.9%) TCSs (99.5%), an unknown etiology (78.0%), and a favorable drug response (2.8% drug\u2010resistant epilepsy [DRE]). The sleep non\u2010TCS subtype (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009229) featured early onset (11.0\u2009years), frequent (\u22651 seizure\/month, 52.0%) focal preserved\/impaired consciousness seizures (FPCSs\/FICSs, 96.9%), an association with etiology of malformations of cortical development (27.9%), and a high rate of DRE (62.9%). Furthermore, an evolution pattern was found in the previous EpSRS cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009103), marked by a transition from the sleep TCS subtype into awake FPCS\/FICS pattern (52.5% were diagnosed as temporal lobe epilepsy), with the DRE proportion surging from 5.2% to 39.0%. This phenotypic evolution could be predicted by later age at epilepsy onset, female sex, and a history of febrile seizures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>This study establishes a practical framework for classifying EpSRS, which is useful for predicting prognosis and evaluating etiology. It should be noted that among patients with the sleep TCS subtype, a transition into an awake FPCS\/FICS pattern is associated with an increased risk of DRE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70447","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:17:56Z","timestamp":1786465076000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical subtypes and sleep\u2013wake evolution pattern in epilepsy manifesting as sleep\u2010related seizures"],"prefix":"10.1002","author":[{"given":"Jinqi","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Neurology Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"},{"name":"Nanhu Brain\u2010Computer Interface Institute  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sha","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingqi","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurology Sir Run Run Shaw Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongjin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7409-0059","authenticated-orcid":false,"given":"Xiao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruotong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenchuan","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Neurology Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingli","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurology Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5165-2613","authenticated-orcid":false,"given":"Pu","family":"Miao","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou 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