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Miron G, Müller PM, Holtkamp M. Diagnostic and prognostic value of EEG patterns recorded on foramen ovale and epidural peg electrodes. Clin Neurophysiol 2022; 143:107-115. [DOI: 10.1016/j.clinph.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
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Trivisano M, Muccioli L, Ferretti A, Lee HF, Chi CS, Bisulli F. Risk of SUDEP during infancy. Epilepsy Behav 2022; 131:107896. [PMID: 33741238 DOI: 10.1016/j.yebeh.2021.107896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 11/03/2022]
Abstract
Risk of sudden unexpected death in epilepsy (SUDEP) in children is influenced by different factors such as etiology, seizure type and frequency, treatment, and environment. A greater severity of epilepsy, in terms of seizure frequency, seizures type, especially with nocturnal generalized tonic-clonic seizures (GTCS), and resistance to anti-seizure medication are predisposing factors to SUDEP. Potential mechanisms of SUDEP might involve respiratory, cardiovascular, and central autonomic dysfunctions, either combined or in isolation. Patients with epilepsy carrying mutations in cardiac channelopathy genes might be disposed to seizure-induced arrhythmias. Other than in channelopathies, SUDEP has been reported in further patients with genetic epilepsies due to mutations of genes such as DEPDC5, TBC1D24, FHF1, or 5q14.3 deletion. Age-related electro-clinical differences in GTCS may therefore be relevant in explaining differences in SUDEP between adults and children. Typical GTCS represent a rare seizure type in infants and toddlers, they are characterized by a shorter tonic phase and, in direct proportion, by shorter postictal generalized EEG suppression (PGES). The presence of night-time supervision has been found to reduce SUDEP risk, likely reducing SUDEP incidence in children. Reconsideration of safety protocols in epilepsy monitoring units with the aim of reducing the risk of SUDEP, and the use of devices for seizure detection, might contribute to reduce the risk of death in patients affected by epilepsy. This article is part of the Special Issue "Severe Infantile Epilepsies".
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Affiliation(s)
- Marina Trivisano
- Rare and Epilepsies Unit, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy.
| | - Lorenzo Muccioli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Alessandro Ferretti
- Rare and Epilepsies Unit, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
| | - Hsiu-Fen Lee
- Division of Pediatric Neurology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Shiang Chi
- Division of Pediatric Neurology, Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Francesca Bisulli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Intracranial EEG seizure onset and termination patterns and their association. Epilepsy Res 2021; 176:106739. [PMID: 34455176 DOI: 10.1016/j.eplepsyres.2021.106739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study of seizure onset and termination patterns has the potential to enhance our understanding of the underlying mechanisms of seizure generation and cessation. It is largely unclear whether seizures with distinct onset patterns originate from varying network interactions and terminate through different termination pathways. METHODS We investigated the morphology and location of 103 intracranial EEG seizure onset and termination patterns from 20 patients with drug-resistant focal epilepsy. We determined if seizure onset patterns were associated with specific termination patterns. Finally, we looked at network interactions prior to the generation of distinct seizure onset patterns by calculating directed functional connectivity matrices. RESULTS We identified nine seizure onset and six seizure termination patterns. The most common onset pattern was Low-Voltage Fast Activity (36 %), and the most frequent termination pattern was Burst Suppression (44 %). All seizures with fast (>13 Hz) termination patterns had a fast (>13 Hz) onset pattern type. Almost any onset pattern could terminate with the Burst Suppression and rhythmic Spike/PolySpike and Wave (rSW/rPSW) termination patterns. Seizures with a fast activity onset had higher inflow to the seizure onset zone from other regions in the gamma and high gamma frequency ranges prior to their generation compared to seizures with a slow onset. SIGNIFICANCE Our observations suggest that different mechanisms underlie the generation of different seizure onset patterns although seizure onset patterns can share a common termination pattern. Possible mechanisms underlying these patterns are discussed.
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Autonomic aspects of sudden unexpected death in epilepsy (SUDEP). Clin Auton Res 2018; 29:151-160. [DOI: 10.1007/s10286-018-0576-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/07/2018] [Indexed: 12/25/2022]
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Abstract
SUMMARY Sudden unexpected death in epilepsy (SUDEP) remains a leading cause of epilepsy-related death, and yet, its pathogenic mechanisms remain ill-defined. Although epidemiological studies of SUDEP in heterogenous populations have established a number of clinical associations, evaluation and stratification of individual risk remains difficult. Thus, potential markers as predictors of risk of SUDEP are important not only clinically but also for research on SUDEP prevention. Recordings from rare monitored cases of SUDEP demonstrate postictal generalized EEG suppression after terminal seizures, raising expectations that postictal generalized EEG suppression may identify individuals at higher risk. In this review, we consider the literature on postictal generalized EEG suppression and evaluate its relevance and utility as a possible marker of SUDEP.
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Autonomic changes following generalized tonic clonic seizures: An analysis of adult and pediatric patients with epilepsy. Epilepsy Res 2015. [DOI: 10.1016/j.eplepsyres.2015.06.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Afra P, Jouny CC, Bergey GK. Termination patterns of complex partial seizures: An intracranial EEG study. Seizure 2015; 32:9-15. [PMID: 26552555 DOI: 10.1016/j.seizure.2015.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/08/2015] [Accepted: 08/12/2015] [Indexed: 01/02/2023] Open
Abstract
PURPOSE While seizure onset patterns have been the subject of many reports, there have been few studies of seizure termination. In this study we report the incidence of synchronous and asynchronous termination patterns of partial seizures recorded with intracranial arrays. METHODS Data were collected from patients with intractable complex partial seizures undergoing presurgical evaluations with intracranial electrodes. Patients with seizures originating from mesial temporal and neocortical regions were grouped into three groups based on patterns of seizure termination: synchronous only (So), asynchronous only (Ao), or mixed (S/A, with both synchronous and asynchronous termination patterns). RESULTS 88% of the patients in the MT group had seizures with a synchronous pattern of termination exclusively (38%) or mixed (50%). 82% of the NC group had seizures with synchronous pattern of termination exclusively (52%) or mixed (30%). In the NC group, there was a significant difference of the range of seizure durations between So and Ao groups, with Ao exhibiting higher variability. Seizures with synchronous termination had low variability in both groups. CONCLUSIONS Synchronous seizure termination is a common pattern for complex partials seizures of both mesial temporal or neocortical onset. This may reflect stereotyped network behavior or dynamics at the seizure focus.
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Affiliation(s)
- Pegah Afra
- Department of Neurology, School of Medicine, University of Utah, Salt Lake City, UT, United States.
| | - Christopher C Jouny
- Department of Neurology, Johns Hopkins Epilepsy Center, Johns Hopkins University School of Medicine, United States
| | - Gregory K Bergey
- Department of Neurology, Johns Hopkins Epilepsy Center, Johns Hopkins University School of Medicine, United States
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Kothare SV, Singh K. Cardiorespiratory abnormalities during epileptic seizures. Sleep Med 2014; 15:1433-9. [PMID: 25311834 DOI: 10.1016/j.sleep.2014.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 07/17/2014] [Accepted: 08/22/2014] [Indexed: 01/01/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death in young and otherwise healthy patients with epilepsy, and sudden death is at least 20 times more common in epilepsy patients as compared to patients without epilepsy. A significant proportion of patients with epilepsy experience cardiac and respiratory complications during seizures. These cardiorespiratory complications are suspected to be a significant risk factor for SUDEP. Sleep physicians are increasingly involved in the care of epilepsy patients and a recognition of these changes in relation to seizures while a patient is under their care may improve their awareness of these potentially life-threatening complications that may occur during sleep studies. This paper details these cardiopulmonary changes that take place in relation to epileptic seizures and how these changes may relate to the occurrence of SUDEP.
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Affiliation(s)
- Sanjeev V Kothare
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Medical Center, New York, NY, USA.
| | - Kanwaljit Singh
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Medical Center, New York, NY, USA; Department of Pediatrics (Neurology), University of Massachusetts Medical School, Worcester, MA, USA
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Kim SH, Nordli DR, Berg AT, Koh S, Laux L. Ictal ontogeny in Dravet syndrome. Clin Neurophysiol 2014; 126:446-55. [PMID: 25046982 DOI: 10.1016/j.clinph.2014.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/08/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To define seizure characteristics of Dravet syndrome (DS) with video-electroencephalographic (EEG) recording in different age groups. METHODS We reviewed 23 patients with 63 seizures in different age groups: group 1 (0-5years old); group 2 (6-10years old); and group 3 (11 or above). RESULTS We included 7, 11 and 5 patients in groups 1, 2, and 3 respectively. Younger children had seizures while awake (p=0.005), provoked seizures (p=0.05), focal seizure semiology (p=0.02) and long seizure duration (p=0.0004). Older children had seizures from sleep (p=0.004), generalized seizure semiology (p=0.01) and short seizure duration (p=0.0007). A generalized ictal discharge was the most commonly observed EEG pattern (15/23, 65%), more frequently found in older children (p=0.01). Ten patients (43%) had unclassified seizures or seizures with discordant EEG results. Postictal EEG suppression was found in 9 (39%). CONCLUSION The phenotype of seizures and ictal EEG patterns in DS vary with age. SIGNIFICANCE These findings will enhance the recognition of DS in the adolescent population. The incidence of postictal EEG suppression seen in DS is significant because it is a possible biomarker for sudden unexpected death in epilepsy.
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Affiliation(s)
- Se Hee Kim
- Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Douglas R Nordli
- Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne T Berg
- Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sookyong Koh
- Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Linda Laux
- Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Abstract
Several potential pathophysiologic phenomena, including "cerebral shutdown," are postulated to be responsible for SUDEP. Since the evidence for a seizure-related mechanism is strong, a poor understanding of the physiology of human seizure termination is a major handicap. However, rather than a failure of a single homeostatic mechanism, such as postictal arousal, it may be a "perfect storm" created by the lining up of a several factors that lead to death.
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Pavlova M, Singh K, Abdennadher M, Katz ES, Dworetzky BA, White DP, Llewellyn N, Kothare SV. Comparison of cardiorespiratory and EEG abnormalities with seizures in adults and children. Epilepsy Behav 2013; 29:537-41. [PMID: 24140516 DOI: 10.1016/j.yebeh.2013.09.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022]
Abstract
Cardiopulmonary dysfunction and postictal generalized EEG suppression (PGES) are proposed as possible risk factors for the occurrence of SUDEP. The evolution of cardiorespiratory abnormalities with seizures has not been systematically studied for any age-related findings. Additionally, not many studies have looked into the possible effect of age-related brain maturation on PGES. The purpose of this study was to compare these SUDEP risk factors in adults versus children. We prospectively recorded cardiopulmonary abnormalities during seizures using pulse oximetry, EKG, and respiratory inductance plethysmography. Linear and logistic regression models adjusting for multiple seizures in a single patient were used to compare the cardiorespiratory and EEG findings between adults and children. We recorded 101 seizures in 26 children and 55 seizures in 22 adults. Ictal central apnea and bradycardia occurred more often in children than in adults (p=0.02 and p=0.008, respectively), while ictal tachycardia occurred more often in adults (p=0.001) than in children. Postictal generalized EEG suppression of longer duration occurred more often in adults (p=0.003) than in children. Minimum O2 saturation and seizure duration/generalization/lateralization did not significantly differ between adults and children (p>0.1). Children had more frontal lobe seizures, and adults had more temporal lobe seizures recorded (p=0.01). There may be an age-related effect on cardiorespiratory and EEG abnormalities associated with seizures, with higher rates of apnea and bradycardia in children and a much higher prevalence of PGES of longer duration in adults. This may indicate why, despite lower rates of cardiopulmonary dysfunction, adults die more frequently from SUDEP than children.
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Affiliation(s)
- Milena Pavlova
- Division of Epilepsy, Neurophysiology, and Sleep, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Freitas J, Kaur G, Baca-Vaca Fernandez G, Tatsuoka C, Kaffashi F, Loparo KA, Rao S, Loplumlert J, Kaiboriboon K, Amina S, Tuxhorn I, Lhatoo SD. Age-specific periictal electroclinical features of generalized tonic-clonic seizures and potential risk of sudden unexpected death in epilepsy (SUDEP). Epilepsy Behav 2013; 29:289-94. [PMID: 24011708 PMCID: PMC3799796 DOI: 10.1016/j.yebeh.2013.08.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/07/2013] [Accepted: 08/09/2013] [Indexed: 11/28/2022]
Abstract
Generalized tonic-clonic seizure (GTCS) is the commonest seizure type associated with sudden unexpected death in epilepsy (SUDEP). This study examined the semiological and electroencephalographic differences (EEG) in the GTCSs of adults as compared with those of children. The rationale lies on epidemiological observations that have noted a tenfold higher incidence of SUDEP in adults. We analyzed the video-EEG data of 105 GTCS events in 61 consecutive patients (12 children, 23 seizure events and 49 adults, 82 seizure events) recruited from the Epilepsy Monitoring Unit. Semiological, EEG, and 3-channel EKG features were studied. Periictal seizure phase durations were analyzed including tonic, clonic, total seizure, postictal EEG suppression (PGES), and recovery phases. Heart rate variability (HRV) measures including RMSSD (root mean square successive difference of RR intervals), SDNN (standard deviation of NN intervals), and SDSD (standard deviation of differences) were analyzed (including low frequency/high frequency power ratios) during preictal baseline and ictal and postictal phases. Generalized estimating equations (GEEs) were used to find associations between electroclinical features. Separate subgroup analyses were carried out on adult and pediatric age groups as well as medication groups (no antiepileptic medication cessation versus unchanged or reduced medication) during admission. Major differences were seen in adult and pediatric seizures with total seizure duration, tonic phase, PGES, and recovery phases being significantly shorter in children (p<0.01). Generalized estimating equation analysis, using tonic phase duration as the dependent variable, found age to correlate significantly (p<0.001), and this remained significant during subgroup analysis (adults and children) such that each 0.12-second increase in tonic phase duration correlated with a 1-second increase in PGES duration. Postictal EEG suppression durations were on average 28s shorter in children. With cessation of medication, total seizure duration was significantly increased by a mean value of 8s in children and 11s in adults (p<0.05). Tonic phase duration also significantly increased with medication cessation, and although PGES durations increased, this was not significant. Root mean square successive difference was negatively correlated with PGES duration (longer PGES durations were associated with decreased vagally mediated heart rate variability; p<0.05) but not with tonic phase duration. This study clearly points out identifiable electroclinical differences between adult and pediatric GTCSs that may be relevant in explaining lower SUDEP risk in children. The findings suggest that some prolonged seizure phases and prolonged PGES duration may be electroclinical markers of SUDEP risk and merit further study.
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Affiliation(s)
- Joel Freitas
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Phone +1-216-844-5855, Fax +1-216-844-3160,Neurology Department, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Gurmeen Kaur
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Phone +1-216-844-5855, Fax +1-216-844-3160
| | - Guadalupe Baca-Vaca Fernandez
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Phone +1-216-844-5855, Fax +1-216-844-3160
| | - Curtis Tatsuoka
- Neurological Outcomes Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA
| | - Farhad Kaffashi
- Department of Electrical Engineering and Computer Sciences, Case School of Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, USA
| | - Kenneth A Loparo
- Department of Electrical Engineering and Computer Sciences, Case School of Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, USA
| | - Shyam Rao
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Phone +1-216-844-5855, Fax +1-216-844-3160
| | - Jakrin Loplumlert
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Phone +1-216-844-5855, Fax +1-216-844-3160
| | - Kitti Kaiboriboon
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Phone +1-216-844-5855, Fax +1-216-844-3160
| | - Shahram Amina
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Phone +1-216-844-5855, Fax +1-216-844-3160
| | - Ingrid Tuxhorn
- Division of Pediatric Epilepsy, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA
| | - Samden D Lhatoo
- Epilepsy Center, Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA Phone +1-216-844-5855, Fax +1-216-844-3160
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Lamberts RJ, Gaitatzis A, Sander JW, Elger CE, Surges R, Thijs RD. Postictal generalized EEG suppression: an inconsistent finding in people with multiple seizures. Neurology 2013; 81:1252-6. [PMID: 23966251 DOI: 10.1212/wnl.0b013e3182a6cbeb] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the consistency and facilitating cofactors of postictal generalized EEG suppression (PGES) of >20 seconds after convulsive seizures (CS), a suggested predictor of sudden unexpected death in epilepsy risk. METHODS We retrospectively reviewed video-EEG data of people with ≥2 recorded CS. Presence and duration of PGES were assessed by 2 independent observers blinded to patient status. Intraindividual consistency of PGES >20 seconds was determined and correlations with clinical characteristics were analyzed after correction for individual effects and the varying number of seizures. RESULTS One hundred fifty-four seizures in 59 people were analyzed. PGES >20 seconds was found in 37 individuals (63%) and 57 (37%) of CS. The proportion of persons in whom PGES occurred consistently (presence or absence of PGES >20 seconds in all CS) was lower in those with more CS. PGES of >20 seconds was more frequent in seizures arising from sleep (odds ratio 3.29, 95% confidence interval 1.21-8.96) and when antiepileptic medication was tapered (odds ratio 4.80, 95% confidence interval 1.27-18.14). CONCLUSION Apparent PGES consistency was less frequent in people with more CS recorded, suggesting that PGES is an inconsistent finding in any one individual. Thus, we believe that PGES >20 seconds is not a reliable predictor of sudden unexpected death in epilepsy. Sleep and antiepileptic drug reduction appear to facilitate the occurrence of PGES.
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Affiliation(s)
- Robert J Lamberts
- From the SEIN-Stichting Epilepsie Instellingen Nederland (R.J.L., A.G., J.W.S., R.D.T.), Heemstede, the Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London, and Epilepsy Society, Chalfont St. Peter, UK; Department of Epileptology (C.E.E., R.S.), University Hospital Bonn, Germany; and Department of Neurology (R.D.T.), LUMC Leiden University Medical Center, Leiden, the Netherlands
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Lamberts RJ, Laranjo S, Kalitzin SN, Velis DN, Rocha I, Sander JW, Thijs RD. Postictal generalized EEG suppression is not associated with periictal cardiac autonomic instability in people with convulsive seizures. Epilepsia 2013; 54:523-9. [PMID: 23157655 PMCID: PMC3580122 DOI: 10.1111/epi.12021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Postictal generalized EEG suppression (PGES) seems to be a pathophysiologic hallmark in ictal recordings of sudden unexpected death in epilepsy (SUDEP). It has recently been suggested that presence and duration of PGES might be a predictor of SUDEP risk. Little is known about the etiology of PGES. METHODS We conducted a retrospective case-control study in 50 people with convulsive seizures (CS) recorded on digital video-electroencephalography (EEG). One CS per individual was reviewed for presence and duration of PGES by two independent observers: Preictal and postictal heart rate (HR) (1 min before seizure onset and 1, 3, 5, 15, and 30 min after seizure end) and frequency domain measures of heart rate variability (HRV), including the ratio of low frequency (LF) versus high frequency (HF) power, were analyzed. The relationship between PGES and periictal autonomic changes was evaluated, as well as its association with several clinical variables. KEY FINDINGS Thirty-seven individuals (74%) exhibited PGES and 13 (26%) did not. CS resulted in a significant increase of periictal HR and the LF/HF ratio. PGES was associated with neither periictal HR (mean HR difference between PGES+ and PGES- seizures: -2 beats per minute [bpm], 95% confidence interval [CI] -10 to +6 bpm) nor HRV change. There was no association between the duration of PGES and periictal HR change. People with PGES were more likely to be asleep before seizure onset (odds ratio [OR] 4.7, 95% CI 1.2-18.3) and had a higher age of onset of epilepsy (median age 15 vs. 4 years). SIGNIFICANCE PGES was not associated with substantial changes in measures of cardiac autonomic instability but was more prevalent in CS arising from sleep.
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Affiliation(s)
- Robert J Lamberts
- SEIN - Epilepsy Institute in The Netherlands Foundation, Heemstede, The Netherlands
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15
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Poh MZ, Loddenkemper T, Reinsberger C, Swenson NC, Goyal S, Madsen JR, Picard RW. Autonomic changes with seizures correlate with postictal EEG suppression. Neurology 2012; 78:1868-76. [PMID: 22539579 DOI: 10.1212/wnl.0b013e318258f7f1] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) poses a poorly understood but considerable risk to people with uncontrolled epilepsy. There is controversy regarding the significance of postictal generalized EEG suppression as a biomarker for SUDEP risk, and it remains unknown whether postictal EEG suppression has a neurologic correlate. Here, we examined the profile of autonomic alterations accompanying seizures with a wrist-worn biosensor and explored the relationship between autonomic dysregulation and postictal EEG suppression. METHODS We used custom-built wrist-worn sensors to continuously record the sympathetically mediated electrodermal activity (EDA) of patients with refractory epilepsy admitted to the long-term video-EEG monitoring unit. Parasympathetic-modulated high-frequency (HF) power of heart rate variability was measured from concurrent EKG recordings. RESULTS A total of 34 seizures comprising 22 complex partial and 12 tonic-clonic seizures from 11 patients were analyzed. The postictal period was characterized by a surge in EDA and heightened heart rate coinciding with persistent suppression of HF power. An increase in the EDA response amplitude correlated with an increase in the duration of EEG suppression (r = 0.81, p = 0.003). Decreased HF power correlated with an increase in the duration of EEG suppression (r = -0.87, p = 0.002). CONCLUSION The magnitude of both sympathetic activation and parasympathetic suppression increases with duration of EEG suppression after tonic-clonic seizures. These results provide autonomic correlates of postictal EEG suppression and highlight a critical window of postictal autonomic dysregulation that may be relevant in the pathogenesis of SUDEP.
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Affiliation(s)
- M-Z Poh
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA.
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Surges R, Strzelczyk A, Scott CA, Walker MC, Sander JW. Postictal generalized electroencephalographic suppression is associated with generalized seizures. Epilepsy Behav 2011; 21:271-4. [PMID: 21570920 DOI: 10.1016/j.yebeh.2011.04.008] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/07/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
Abstract
Postictal generalized electroencephalographic suppression (PGES) may be involved in sudden unexpected death in epilepsy (SUDEP). We examined whether the occurrence of PGES depends on seizure type and whether PGES occurs more frequently in people with epilepsy who died suddenly. EEG recordings of people with pharmacoresistant focal epilepsies who died from SUDEP after presurgical video/EEG telemetry were compared with recordings of living controls. To test if PGES depends on seizure type, EEG recordings of people with temporal lobe epilepsy who had complex partial seizures (CPS) and secondarily generalized tonic-clonic seizures (GTCS) were reviewed. A total of 122 seizures in 57 individuals have been included. PGES was observed in 15% of all seizures in 26% of all individuals. Secondarily GTCS were significantly associated with PGES. Neither presence nor duration of PGES differed between the SUDEP and control groups. In conclusion, PGES is facilitated by secondarily GTCS, but does not seem to be an independent risk factor for SUDEP.
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Affiliation(s)
- Rainer Surges
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom.
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Lhatoo SD, Faulkner HJ, Dembny K, Trippick K, Johnson C, Bird JM. An electroclinical case-control study of sudden unexpected death in epilepsy. Ann Neurol 2010; 68:787-96. [DOI: 10.1002/ana.22101] [Citation(s) in RCA: 259] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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