Journal article
Severe, Non-apneic Respiratory Dysfunction and Hypoxia following Generalized Convulsive Seizures
Annals of neurology, PMID 7707449
01/27/2026
DOI: 10.1002/ana.78164
PMID: 41589457
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a devastating consequence of some generalized convulsive seizures (GCS). Recent work has focused on seizure related apnea as a biomarker of SUDEP risk, frequently without characterizing the adequacy of non-apneic ventilation or identifying other dysfunctional breathing patterns. We hypothesized that GCS frequently induce immediate, severe, non-apneic respiratory dysfunction that can induce critical hypoxia and bradycardia and sought to characterize breathing patterns after GCS.
Adult patients admitted to an epilepsy monitoring unit were studied. The effects of GCS on breathing and heart rate were analyzed using nasal pressure transducers, chest and abdominal respiratory inductance plethysmography, capillary oxygen saturation, transcutaneous CO
, electrocardiogram, electroencephalogram, and expert audiovisual analysis. Correlation analyses, the Mann-Whitney test, and an unpaired t test were used to analyze relationships between dysfunctional breathing patterns and both the severity of postictal hypoxemia and the heart rate.
Thirty-two GCS from 22 patients were analyzed and 31 exhibited 1 or more of the following breathing patterns: disordered rhythmicity (n = 28/32, 87.5%), shallow breathing (n = 12/32, 37.5%), thoracoabdominal asynchrony (n = 24/30, 80.0%), and upper airway obstruction (n = 30/32, 93.8%). Oxygen desaturation was more severe when postictal breathing was shallow or irregular in amplitude. The latter was associated with absolute or relative bradycardia.
Nonfatal GCS frequently induce immediate, severe, non-apneic respiratory dysfunction temporally associated with severe hypoxia and bradycardia. Our study suggests that postictal respiratory and cardiac function are tightly coupled and highlights the importance of including all the relevant pathologic variables in studies of SUDEP pathogenesis. ANN NEUROL 2026.
Details
- Title: Subtitle
- Severe, Non-apneic Respiratory Dysfunction and Hypoxia following Generalized Convulsive Seizures
- Creators
- Haley E Pysick - University of IowaRup K Sainju - University of IowaRoshni Nair - University of Iowa, NeurologyDeidre N Dragon - University of IowaEduardo Bravo - University of IowaLaura Vilella - The University of Texas Health Science CenterXiaojin Li - The University of Texas Health Science CenterSamden D Lhatoo - The University of Texas Health Science CenterGeorge B Richerson - University of IowaBrian K Gehlbach - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Annals of neurology, PMID 7707449
- DOI
- 10.1002/ana.78164
- PMID
- 41589457
- ISSN
- 0364-5134
- eISSN
- 1531-8249
- Publisher
- Wiley
- Grant note
- National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke: U01 NS090414, R01 NS113764 NIH/National Heart, Lung, and Blood Institute: R38 HL150208
This work was supported by grants from the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke (U01 NS090414 and R01 NS113764); and NIH/National Heart, Lung, and Blood Institute (R38 HL150208). The SenTec Transcutaneous Monitoring System was provided by the company. Neither this company nor the NIH had any role in study design, data collection, data analysis, data interpretation, or writing of the report. The authors gratefully acknowledge the staff of the University of Iowa Epilepsy Monitoring Unit and the patients and families who participated in this study. We also thank K. Greiner for her editorial work.
- Language
- English
- Electronic publication date
- 01/27/2026
- Academic Unit
- Neurology; Molecular Physiology and Biophysics; Pulmonary, Critical Care, and Occupational Medicine; Iowa Neuroscience Institute; Neurosurgery; Health, Sport, and Human Physiology ; Internal Medicine
- Record Identifier
- 9985132206702771
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