Timing is everything: Expert opinion on researching epilepsy rhythms by the ILAE Task Force on Chronobiology

Recurrent seizures, the hallmark of epilepsy, are influenced by rhythms operating over multiple timescales. Chronobiology is the study of biological timing that aims to explain temporal patterns of events like seizures. Fueled by recent advances in genetics, computational modeling, and device engineering, the chronobiology of epilepsy is now a burgeoning field poised to shed new light on mechanisms governing seizure recurrence. Although seizures were long believed to occur at random, epilepsy is now understood as a cyclical disorder, and time-varying therapeutic interventions are increasingly possible. Yet, potential barriers to progress in this field exist, such as reconciling variable experimental methodology, deconvolving coexisting rhythms, and harnessing the power of new technologies and data sharing. In this report from the International League Against Epilepsy Task Force on Chronobiology, we review these knowledge gaps and offer recommendations to help close them. By unraveling mechanisms of seizure timing, chronobiology promises to usher in a new era of personalized epilepsy management in which seizures are viewed as predictable, potentially avoidable events.