The onset of pediatric refractory status epilepticus is not distributed uniformly during the day

Status epilepticus (SE) is one of the most common neurological emergencies in children, with an incidence of 17-23/100,000 per year [1–4]. Pediatric SE is associated with a short-term mortality of 0-3% [1,4–8] which is as high as 20-40% [9] in refractory SE (rSE). One of the most disabling features of epilepsy and SE is the apparently unpredictable timing of seizure occurrence [10]. However, seizures, and presumably SE, follow day and multiday rhythms [10–13].

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