{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:43:52Z","timestamp":1786977832457,"version":"build-2736575974"},"reference-count":67,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["K08NS110924"],"award-info":[{"award-number":["K08NS110924"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS131399"],"award-info":[{"award-number":["R01NS131399"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Rest\u2010activity rhythms (RARs) are perturbed in many forms of neuropsychiatric illness. In this study, we applied wrist actigraphy to describe RAR perturbations in intellectually disabled adults with epilepsy (\u201cE\u2009+\u2009ID\u201d), using a cross\u2010sectional case\u2013control design. We examined whether RAR phenotypes correlated with epilepsy severity, deficits in adaptive function, and\/or comorbid psychopathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Caregivers of E\u2009+\u2009ID subjects provided informed consent during routine ambulatory clinic visits and were asked to complete standardized surveys of overall epilepsy severity (GASE, Global Assessment of Severity of Epilepsy), adaptive function (ABAS\u20103, Adaptive Behavior Assessment System\u20103) and psychopathology (ABCL, Adult Behavior Checklist). Caregivers were also asked to ensure that subjects wore an Actiwatch\u20102 device continuously for at least ten days. From actograms, we calculated RAR amplitude, acrophase, robustness, intradaily variability (IV), interdaily stability (IS), and estimates of sleep quantity and timing. We compared these RAR metrics against those from (i) a previously published cohort of adults with epilepsy without ID (E\u2013ID), and (ii) a historical control cohort of age\u2010 and sex\u2010matched intellectually able subjects from the Study of Latinos (SOL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      46 E\u2009+\u2009ID subjects (median age 26, 47% female) provided a median recording duration of 11\u2009days. Surveys reflected low to\n                      <jats:italic>extremely<\/jats:italic>\n                      low levels of adaptive function and low\/subclinical levels of psychopathology. Compared with E\u2010ID and SOL cohorts, E\u2009+\u2009ID subjects displayed significantly lower measures of RAR amplitude, robustness, and IS, with significantly higher IV and total daily sleep. K\u2010means clustering of E\u2009+\u2009ID subjects recognized a cluster with pronounced hypoactivity, hypersomnia, and elevated rhythm fragmentation (cluster A), an intermediate group with metrics similar to E\u2010ID, and cluster \u201cC\u201d subjects that featured hyper\u2010robust and high amplitude RARs. All three clusters were similar in age, body mass index, antiseizure medication (ASM) polytherapy, ABAS3, and ABCL scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Adults with epilepsy and intellectual disability display a wide spectrum of RAR phenotypes that do not neatly correlate with measures of adaptive function or epilepsy severity. Prospective studies are necessary to determine whether continuous actigraphic monitoring can sensitively capture changes in chronobiological health that may arise with disease progression, ASM side effects, or other acute health deteriorations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain Language Summary<\/jats:title>\n                    <jats:p>Rest\u2010activity rhythms (RARs) can be measured using continuously worn wrist activity monitors. We show that compared to controls, adults with epilepsy and intellectual disability (E\u2009+\u2009ID) display RARs that are more fragmented, weaker in amplitude, and unstable across days. Within our E\u2009+\u2009ID cohort, we observed a wide spectrum of RAR phenotypes that we clustered into three subtypes, which were similar in overall average measures of adaptive functioning and psychiatric symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi4.70063","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T06:14:48Z","timestamp":1749536088000},"page":"1086-1098","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rest\u2010activity rhythm phenotypes in adults with epilepsy and intellectual disability"],"prefix":"10.1002","volume":"10","author":[{"given":"Nandani","family":"Adhyapak","sequence":"first","affiliation":[{"name":"Department of Neurology, Neuroscience and Psychiatry &amp; Behavioral Sciences Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace E.","family":"Cardenas","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neuroscience and Psychiatry &amp; Behavioral Sciences Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Abboud","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neuroscience and Psychiatry &amp; Behavioral Sciences Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2847-0069","authenticated-orcid":false,"given":"Vaishnav","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neuroscience and Psychiatry &amp; Behavioral Sciences Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awaa371"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2009.80"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnmol.2018.00458"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17060"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1684\/epd.2022.1467"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002060"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2017.08.039"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a9f482"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2021.108191"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12943"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02536.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2021.108324"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2015.04.004"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-021-10938-3"},{"issue":"5","key":"e_1_2_10_16_1","first-page":"519","article-title":"What does better look like in individuals with severe neurodevelopmental impairments? 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