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 Bateman; Orrin Devinsky; George B Richerson; Samden Lhatoo

doi:10.1016/j.yebeh.2019.06.029

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

Journal article

Peer reviewed

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, …

Epilepsy & behavior, Vol.98(Pt A), pp.73-79

09/2019

DOI: 10.1016/j.yebeh.2019.06.029

PMID: 31301453

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https://www.ncbi.nlm.nih.gov/pmc/articles/8975169View

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Abstract

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.\nPatients 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.\nFour 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).\nSeizures 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.\n•Seizures in patients taking serotonin reuptake inhibitors (SRIs) have lower relative risk for Ictal Central Apnea (ICA)•Seizures in patients taking benzodiazepines (BZDs) are associated with shorter ICA duration, but not with ICA incidence.•Seizures in patients taking BZDs have shorter generalized convulsive seizures, as well as PGES durations.•Seizures in patients on SRIs or BZDs have less severe hypoxemia than in the control group (no SRIs or BZDs).

SUDEP

Ictal central apnea

Serotonin reuptake inhibitors

Benzodiazepines

Seizures

Details

Title: Subtitle: The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea
Creators: 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
M.R. Sandhya Rani - NINDS Center for SUDEP Research (CSR), 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
Jaison S Hampson - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Rup K Sainju - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Daniel Friedman - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Maromi Nei - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Catherine Scott - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Brian K Gehlbach - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Norma J Hupp - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Stephan Schuele - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Jennifer Ogren - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Ronald M Harper - Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
Luke Allen - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Beate Diehl - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Lisa M Bateman - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Orrin Devinsky - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
George B Richerson - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Samden Lhatoo - Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
Resource Type: Journal article
Publication Details: Epilepsy & behavior, Vol.98(Pt A), pp.73-79
DOI: 10.1016/j.yebeh.2019.06.029
PMID: 31301453
NLM abbreviation: Epilepsy Behav
ISSN: 1525-5050
eISSN: 1525-5069
Publisher: Elsevier Inc
Grant note: name: NIH/NINDS, award: U01-NS090407, U01-NS090407; DOI: 10.13039/100000065, name: NINDS, award: RFA-NS-14-004; name: Danny Did Foundation
Language: English
Date published: 09/2019
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: 9984070811902771

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