The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea

Nuria Lacuey*, Rita Martins, Laura Vilella, Johnson P. Hampson, M. R.Sandhya Rani, Kingman Strohl, Anita Zaremba, Jaison S. Hampson, Rup K. Sainju, Daniel Friedman, Maromi Nei, Catherine Scott, Brian K. Gehlbach, Norma J. Hupp, Stephan Schuele, Jennifer Ogren, Ronald M. Harper, Luke Allen, Beate Diehl, Lisa M. BatemanOrrin Devinsky, George B. Richerson, Samden Lhatoo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective: Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy. Methods: Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group. Results: Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05). Conclusions: Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.

Original languageEnglish (US)
Pages (from-to)73-79
Number of pages7
JournalEpilepsy and Behavior
StatePublished - Sep 2019


  • Benzodiazepines
  • Ictal central apnea
  • Seizures
  • Serotonin reuptake inhibitors

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Behavioral Neuroscience


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