TY - JOUR
T1 - Postconvulsive central apnea as a biomarker for sudden unexpected death in epilepsy (SUDEP)
AU - Vilella, Laura
AU - Lacuey, Nuria
AU - Hampson, Johnson P.
AU - Rani, M. R.Sandhya
AU - Sainju, Rup K.
AU - Friedman, Daniel
AU - Nei, Maromi
AU - Strohl, Kingman
AU - Scott, Catherine
AU - Gehlbach, Brian K.
AU - Zonjy, Bilal
AU - Hupp, Norma J.
AU - Zaremba, Anita
AU - Shafiabadi, Nassim
AU - Zhao, Xiuhe
AU - Reick-Mitrisin, Victoria
AU - Schuele, Stephan
AU - Ogren, Jennifer
AU - Harper, Ronald M.
AU - Diehl, Beate
AU - Bateman, Lisa
AU - Devinsky, Orrin
AU - Richerson, George B.
AU - Ryvlin, Philippe
AU - Lhatoo, Samden D.
N1 - Funding Information:
L. Vilella, N. Lacuey, J. Hampson, M. Sandhya Rani, R. Sanju, D. Friedman, M. Nei, K. Strohl, C. Scott, B. Gehlbach, B. Zonjy, N. Hupp, A. Zaremba, N. Shafiabadi, X. Zhao, V. Reick-Mitrisin, S. Schuele, J. Ogren, R. Harper, B. Diehl, L. Bateman, and O. Devinsky report no disclosures relevant to the manuscript. G. Richerson is funded by the Center for SUDEP Research: NIH/NINDS U01-NS090414. P. Ryvlin reports no disclosures relevant to the manuscript. S. Lhatoo is funded by the Center for SUDEP Research: NIH/NINDS U01-NS090405 and NIH/NINDS U01-NS090407. Go to Neurology.org/N for full disclosures.
Publisher Copyright:
© American Academy of Neurology 2018.
PY - 2019/1/15
Y1 - 2019/1/15
N2 - ObjectiveTo characterize peri-ictal apnea and postictal asystole in generalized convulsive seizures (GCS) of intractable epilepsy.MethodsThis was a prospective, multicenter epilepsy monitoring study of autonomic and breathing biomarkers of sudden unexpected death in epilepsy (SUDEP) in patients ≥18 years old with intractable epilepsy and monitored GCS. Video-EEG, thoracoabdominal excursions, nasal airflow, capillary oxygen saturation, and ECG were analyzed.ResultsWe studied 148 GCS in 87 patients. Nineteen patients had generalized epilepsy; 65 had focal epilepsy; 1 had both; and the epileptogenic zone was unknown in 2. Ictal central apnea (ICA) preceded GCS in 49 of 121 (40.4%) seizures in 23 patients, all with focal epilepsy. Postconvulsive central apnea (PCCA) occurred in 31 of 140 (22.1%) seizures in 22 patients, with generalized, focal, or unknown epileptogenic zones. In 2 patients, PCCA occurred concurrently with asystole (near-SUDEP), with an incidence rate of 10.2 per 1,000 patient-years. One patient with PCCA died of probable SUDEP during follow-up, suggesting a SUDEP incidence rate 5.1 per 1,000 patient-years. No cases of laryngospasm were detected. Rhythmic muscle artifact synchronous with breathing was present in 75 of 147 seizures and related to stertorous breathing (odds ratio 3.856, 95% confidence interval 1.395-10.663, p = 0.009).ConclusionsPCCA occurred in both focal and generalized epilepsies, suggesting a different pathophysiology from ICA, which occurred only in focal epilepsy. PCCA was seen in 2 near-SUDEP cases and 1 probable SUDEP case, suggesting that this phenomenon may serve as a clinical biomarker of SUDEP. Larger studies are needed to validate this observation. Rhythmic postictal muscle artifact is suggestive of post-GCS breathing effort rather than a specific biomarker of laryngospasm.
AB - ObjectiveTo characterize peri-ictal apnea and postictal asystole in generalized convulsive seizures (GCS) of intractable epilepsy.MethodsThis was a prospective, multicenter epilepsy monitoring study of autonomic and breathing biomarkers of sudden unexpected death in epilepsy (SUDEP) in patients ≥18 years old with intractable epilepsy and monitored GCS. Video-EEG, thoracoabdominal excursions, nasal airflow, capillary oxygen saturation, and ECG were analyzed.ResultsWe studied 148 GCS in 87 patients. Nineteen patients had generalized epilepsy; 65 had focal epilepsy; 1 had both; and the epileptogenic zone was unknown in 2. Ictal central apnea (ICA) preceded GCS in 49 of 121 (40.4%) seizures in 23 patients, all with focal epilepsy. Postconvulsive central apnea (PCCA) occurred in 31 of 140 (22.1%) seizures in 22 patients, with generalized, focal, or unknown epileptogenic zones. In 2 patients, PCCA occurred concurrently with asystole (near-SUDEP), with an incidence rate of 10.2 per 1,000 patient-years. One patient with PCCA died of probable SUDEP during follow-up, suggesting a SUDEP incidence rate 5.1 per 1,000 patient-years. No cases of laryngospasm were detected. Rhythmic muscle artifact synchronous with breathing was present in 75 of 147 seizures and related to stertorous breathing (odds ratio 3.856, 95% confidence interval 1.395-10.663, p = 0.009).ConclusionsPCCA occurred in both focal and generalized epilepsies, suggesting a different pathophysiology from ICA, which occurred only in focal epilepsy. PCCA was seen in 2 near-SUDEP cases and 1 probable SUDEP case, suggesting that this phenomenon may serve as a clinical biomarker of SUDEP. Larger studies are needed to validate this observation. Rhythmic postictal muscle artifact is suggestive of post-GCS breathing effort rather than a specific biomarker of laryngospasm.
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U2 - 10.1212/WNL.0000000000006785
DO - 10.1212/WNL.0000000000006785
M3 - Article
C2 - 30568003
AN - SCOPUS:85060012694
VL - 92
SP - E171-E182
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 3
ER -