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Significant postictal hypotension: Expanding the spectrum of seizure‐induced autonomic dysregulation
Author(s) -
Bozorgi Alireza,
Chung Stephanie,
Kaffashi Farhad,
Loparo Kenneth A.,
Sahoo Satya,
Zhang G. Q.,
Kaiboriboon Kitti,
Lhatoo Samden D.
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.12251
Subject(s) - electroencephalography , epilepsy , medicine , heart rate , blood pressure , anesthesia , pulse oximetry , vasovagal syncope , cardiology , autonomic nervous system , electrocardiography , psychiatry , reflex
Summary Periictal autonomic dysregulation is best studied using a “polygraphic” approach: electroencephalography ([ EEG ]), 3‐channel electrocardiography [ ECG ], pulse oximetry, respiration, and continuous noninvasive blood pressure [ BP ]), which may help elucidate agonal pathophysiologic mechanisms leading to sudden unexpected death in epilepsy ( SUDEP ). A number of autonomic phenomena have been described in generalized tonic–clonic seizures ( GTCS ), the most common seizure type associated with SUDEP , including decreased heart rate variability, cardiac arrhythmias, and changes in skin conductance. Postictal generalized EEG suppression ( PGES ) has been identified as a potential risk marker of SUDEP , and PGES has been found to correlate with post‐ GTCS autonomic dysregulation in some patients. Herein, we describe a patient with a GTCS in whom polygraphic measurements were obtained, including continuous noninvasive blood pressure recordings. Significant postictal hypotension lasting >60 s was found, which closely correlated with PGES duration. Similar EEG changes are well described in hypotensive patients with vasovagal syncope and a similar vasodepressor phenomenon, and consequent cerebral hypoperfusion may account for the PGES observed in some patients after a GTCS . This further raises the possibility that profound, prolonged, and irrecoverable hypotension may comprise one potential SUDEP mechanism.