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Cardiopulmonary complications during pediatric seizures: A prelude to understanding SUDEP
Author(s) -
Singh Kanwaljit,
Katz Eliot S.,
Zarowski Marcin,
Loddenkemper Tobias,
Llewellyn Nichelle,
Manganaro Sheryl,
Gregas Matt,
Pavlova Milena,
Kothare Sanjeev V.
Publication year - 2013
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12153
Subject(s) - medicine , epilepsy , anesthesia , neuroscience , psychology , psychiatry
Summary Purpose Sudden unexpected death in epilepsy ( SUDEP ) is an important, unexplained cause of death in epilepsy. Role of cardiopulmonary abnormalities in the pathophysiology of SUDEP is unclear in the pediatric population. Our objective was to assess cardiopulmonary abnormalities during epileptic seizures in children, with the long‐term goal of identifying potential mechanisms of SUDEP . Methods We prospectively recorded cardiopulmonary functions using pulse‐oximetry, electrocardiography ( ECG ), and respiratory inductance plethysmography ( RIP ). Logistic regression was used to evaluate association of cardiorespiratory findings with seizure characteristics and demographics. Key Findings We recorded 101 seizures in 26 children (average age 3.9 years). RIP provided analyzable data in 78% and pulse‐oximetry in 63% seizures. Ictal central apnea was more prevalent in patients with younger age (p = 0.01), temporal lobe (p < 0.001), left‐sided (p < 0.01), symptomatic generalized (p = 0.01), longer duration seizures (p < 0.0002), desaturation (p < 0.0001), ictal bradycardia (p < 0.05), and more antiepileptic drugs ( AED s; p < 0.01), and was less prevalent in frontal lobe seizures (p < 0.01). Ictal bradypnea was more prevalent in left‐sided (p < 0.05), symptomatic generalized seizures (p < 0.01), and in brain magnetic resonance imaging ( MRI ) lesions (p < 0.1). Ictal tachypnea was more prevalent in older‐age (p = 0.01), female gender (p = 0.05), frontal lobe (p < 0.05), right‐sided seizures (p < 0.001), fewer AED s (p < 0.01), and less prevalent in lesional (p < 0.05) and symptomatic generalized seizures (p < 0.05). Ictal bradycardia was more prevalent in male patients (p < 0.05) longer duration seizures (p < 0.05), desaturation (p = 0.001), and more AED s (p < 0.05), and was less prevalent in frontal lobe seizures (p = 0.01). Ictal and postictal bradycardia were directly associated (p < 0.05). Desaturation was more prevalent in longer‐duration seizures (p < 0.0001), ictal apnea (p < 0.0001), ictal bradycardia (p = 0.001), and more AED s (p = 0.001). Significance Potentially life‐threatening cardiopulmonary abnormalities such as bradycardia, apnea, and hypoxemia in pediatric epileptic seizures are associated with predictable patient and seizure characteristics, including seizure subtype and duration.