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Work in chronobiology has shown that cyclical physiological phenomena are ubiquitous, with daily and multiday cycles evident in immune, endocrine, metabolic, neurological, and cardiovascular function. Additionally, work with chronic brain recordings has identified that seizure risk is linked to daily and multiday cycles in brain activity. Here, we provide the first characterization of the relationships between the cyclical modulation of a diverse set of physiological signals, brain activity, and seizure timing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cohort study, 14 subjects underwent chronic ambulatory monitoring with a multimodal wrist\u2010worn sensor (recording heart rate, accelerometry, electrodermal activity, and temperature) and an implanted responsive neurostimulation system (recording interictal epileptiform abnormalities and electrographic seizures). Wavelet and filter\u2013Hilbert spectral analyses characterized circadian and multiday cycles in brain and wearable recordings. Circular statistics assessed electrographic seizure timing and cycles in physiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten subjects met inclusion criteria. The mean recording duration was 232\u2009days. Seven subjects had reliable electroencephalographic seizure detections (mean\u2009=\u200976 seizures). Multiday cycles were present in all wearable device signals across all subjects. Seizure timing was phase locked to multiday cycles in five (temperature), four (heart rate, phasic electrodermal activity), and three (accelerometry, heart rate variability, tonic electrodermal activity) subjects. Notably, after regression of behavioral covariates from heart rate, six of seven subjects had seizure phase locking to the residual heart rate signal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Seizure timing is associated with daily and multiday cycles in multiple physiological processes. Chronic multimodal wearable device recordings can situate rare paroxysmal events, like seizures, within a broader chronobiology context of the individual. Wearable devices may advance the understanding of factors that influence seizure risk and enable personalized time\u2010varying approaches to epilepsy care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.17607","type":"journal-article","created":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T01:04:16Z","timestamp":1681520656000},"page":"1627-1639","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Seizure occurrence is linked to multiday cycles in diverse physiological signals"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6151-043X","authenticated-orcid":false,"given":"Nicholas M.","family":"Gregg","sequence":"first","affiliation":[{"name":"Department of Neurology, Bioelectronics Neurophysiology and Engineering Laboratory Mayo Clinic  Minnesota Rochester USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3456-9628","authenticated-orcid":false,"given":"Tal","family":"Pal\u00a0Attia","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bioelectronics Neurophysiology and Engineering Laboratory Mayo Clinic  Minnesota Rochester USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Nasseri","sequence":"additional","affiliation":[{"name":"School of Engineering University of North Florida  Florida Jacksonville USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1576-9344","authenticated-orcid":false,"given":"Boney","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bioelectronics Neurophysiology and Engineering Laboratory Mayo Clinic  Minnesota Rochester 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Victoria Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0861-8705","authenticated-orcid":false,"given":"Pedro F.","family":"Viana","sequence":"additional","affiliation":[{"name":"School of Neuroscience King's College London  London UK"},{"name":"Faculty of Medicine University of Lisbon  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Richner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bioelectronics Neurophysiology and Engineering Laboratory Mayo Clinic  Minnesota Rochester USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8981-0074","authenticated-orcid":false,"given":"Ewan S.","family":"Nurse","sequence":"additional","affiliation":[{"name":"Seer Medical  Victoria Melbourne Australia"},{"name":"Department of Medicine, St. Vincent's Hospital Melbourne University of Melbourne  Victoria 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