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Lacuey N, Martins R, Vilella L, Hampson JP, Rani MRS, Strohl K, Zaremba A, Hampson JS, Sainju RK, Friedman D, Nei M, Scott C, Gehlbach BK, Hupp NJ, Schuele S, Ogren J, Harper RM, Allen L, Diehl B, Bateman LM, Devinsky O, Richerson GB, Lhatoo S. The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea. Epilepsy Behav 2019; 98:73-79. [PMID: 31301453 PMCID: PMC8975169 DOI: 10.1016/j.yebeh.2019.06.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Nuria Lacuey
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Rita Martins
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Laura Vilella
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | - Johnson P. Hampson
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Kingman Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Medical Center, Cleveland, OH, USA
| | - Anita Zaremba
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | | | - Rup K. Sainju
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Daniel Friedman
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,NYU Langone School of Medicine, New York, NY, USA
| | - Maromi Nei
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Catherine Scott
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Brian K Gehlbach
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Norma J. Hupp
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | - Stephan Schuele
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Northwestern University, Feinberg School of Medicine, Chicago
| | - Jennifer Ogren
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ronald M. Harper
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal,Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Luke Allen
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Beate Diehl
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Lisa M. Bateman
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Department of Neurology, Columbia University, New York, NY, USA
| | - Orrin Devinsky
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,NYU Langone School of Medicine, New York, NY, USA
| | - George B. Richerson
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Samden Lhatoo
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
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Masneuf S, Buetler J, Koester C, Crestani F. Role of α1- and α2-GABA(A) receptors in mediating the respiratory changes associated with benzodiazepine sedation. Br J Pharmacol 2012; 166:339-48. [PMID: 22044283 DOI: 10.1111/j.1476-5381.2011.01763.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE The molecular substrates underlying the respiratory changes associated with benzodiazepine sedation are unknown. We examined the effects of different doses of diazepam and alprazolam on resting breathing in wild-type (WT) mice and clarified the contribution of α1- and α2-GABA(A) receptors, which mediate the sedative and muscle relaxant action of diazepam, respectively, to these drug effects using point-mutated mice possessing either α1H101R- or α2H101R-GABA(A) receptors insensitive to benzodiazepine. EXPERIMENTAL APPROACH Room air breathing was monitored using whole-body plethysmography. Different groups of WT mice were injected i.p. with diazepam (1-100 mg·kg(-1) ), alprazolam (0.3, 1 or 3 mg·kg(-1) ) or vehicle. α1H101R and α2H101R mice received 1 or 10 mg·kg(-1) diazepam or 0.3 or 3 mg·kg(-1) alprazolam. Respiratory frequency, tidal volume, time of expiration and time of inspiration before and 20 min after drug injection were analysed. KEY RESULTS Diazepam (10 mg·kg(-1) ) decreased the time of expiration, thereby increasing the resting respiratory frequency, in WT and α2H101R mice, but not in α1H101R mice. The time of inspiration was shortened in WT and α1H101R mice, but not in α2H101R mice. Alprazolam (1-3 mg·kg(-1) ) stimulated the respiratory frequency by shortening expiration and inspiration duration in WT mice. This tachypnoeic effect was partially conserved in α1H101R mice while absent in α2H101R mice. CONCLUSIONS AND IMPLICATIONS These results identify a specific role for α1-GABA(A) receptors and α2-GABA(A) receptors in mediating the shortening by benzodiazepines of the expiratory and inspiratory phase of resting breathing respectively.
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Affiliation(s)
- S Masneuf
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
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