Premium
Postictal immobility and generalized EEG suppression are associated with the severity of respiratory dysfunction
Author(s) -
Kuo Jonathan,
Zhao Wenjie,
Li ChinShang,
Kennedy Jeffrey D.,
Seyal Masud
Publication year - 2016
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.13312
Subject(s) - anesthesia , epilepsy , ictal , electroencephalography , tonic (physiology) , medicine , arousal , psychology , cardiology , neuroscience , psychiatry
Summary Objective The pathophysiology of sudden unexpected death in epilepsy ( SUDEP ) remains undetermined. Seizures are accompanied by respiratory dysfunction ( RD ). Postictal generalized electroencephalography ( EEG ) suppression ( PGES ) may follow generalized tonic–clonic seizures ( GTCS ). Following GTCS patients have impaired arousal and may be motionless. Patients with SUDEP are usually prone. Postictal immobility (PI) may contribute to SUDEP by not permitting repositioning of the head to allow unimpeded ventilation. To determine whether RD and/or ictal characteristics are associated with PI , we analyzed patients with GTCS in the epilepsy monitoring unit. Method We investigated for associations between PI duration and PGES , ictal/postictal oxygen saturation (SpO 2 ), end‐tidal CO 2 ( ETCO 2 ), seizure localization, duration, and tonic and total convulsive phase duration. We investigated for linkage between PGES and these measures. Results Seventy patients with 181 GTCS and available SpO 2 and/or ETCO 2 data were studied. Simple linear regression analysis by seizures showed that PI duration was associated with peak periictal ETCO 2 (p = 0.03), duration of oxygen desaturation (p = 0.005) and with SpO 2 nadir (p = 0.02). PI duration was not associated with tonic, convulsive phase or total seizure duration. Analysis by patients also showed significant association of PI with RD . Duration of PI was longer following seizures with PGES (p < 0.001). PGES was not associated with the tonic, convulsive phase or total seizure duration. SpO 2 nadir was lower in seizures with PGES (p = 0.046), ETCO 2 peak change (p = 0.003) was higher, and duration of ETCO 2 elevation (p = 0.03) was longer. Multivariable regression analysis showed that PGES and severe RD were associated with PI duration. Significance The duration of PI and presence of PGES are associated with periictal RD . The duration of PI is also associated with the presence of PGES . Seizure duration or duration of the convulsive phase is not associated with PI or PGES . Interventions aimed at reversing impaired arousal and PI may reduce SUDEP risk.