The incidence and significance of periictal apnea in epileptic seizures

Nuria Lacuey; Bilal Zonjy; Johnson P Hampson; M R Sandhya Rani; Anita Zaremba; Rup K Sainju; Brian K Gehlbach; Stephan Schuele; Daniel Friedman; Orrin Devinsky; Maromi Nei; Ronald M Harper; Luke Allen; Beate Diehl; John J Millichap; Lisa Bateman; Mark A Granner; Deidre N Dragon; George B Richerson; Samden D Lhatoo

doi:10.1111/epi.14006

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The incidence and significance of periictal apnea in epileptic seizures

Journal article

Open access

Peer reviewed

The incidence and significance of periictal apnea in epileptic seizures

Nuria Lacuey, Bilal Zonjy, Johnson P Hampson, M R Sandhya Rani, Anita Zaremba, Rup K Sainju, Brian K Gehlbach, Stephan Schuele, Daniel Friedman, Orrin Devinsky, …

Epilepsia (Copenhagen), Vol.59(3), pp.573-582

03/2018

DOI: 10.1111/epi.14006

PMCID: PMC6103445

PMID: 29336036

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Abstract

The aim of this study was to investigate periictal central apnea as a seizure semiological feature, its localizing value, and possible relationship with sudden unexpected death in epilepsy (SUDEP) pathomechanisms. We prospectively studied polygraphic physiological responses, including inductance plethysmography, peripheral capillary oxygen saturation (SpO ), electrocardiography, and video electroencephalography (VEEG) in 473 patients in a multicenter study of SUDEP. Seizures were classified according to the International League Against Epilepsy (ILAE) 2017 seizure classification based on the most prominent clinical signs during VEEG. The putative epileptogenic zone was defined based on clinical history, seizure semiology, neuroimaging, and EEG. Complete datasets were available in 126 patients in 312 seizures. Ictal central apnea (ICA) occurred exclusively in focal epilepsy (51/109 patients [47%] and 103/312 seizures [36.5%]) (P < .001). ICA was the only clinical manifestation in 16/103 (16.5%) seizures, and preceded EEG seizure onset by 8 ± 4.9 s, in 56/103 (54.3%) seizures. ICA ≥60 s was associated with severe hypoxemia (SpO <75%). Focal onset impaired awareness (FOIA) motor onset with automatisms and FOA nonmotor onset semiologies were associated with ICA presence (P < .001), ICA duration (P = .002), and moderate/severe hypoxemia (P = .04). Temporal lobe epilepsy was highly associated with ICA in comparison to extratemporal epilepsy (P = .001) and frontal lobe epilepsy (P = .001). Isolated postictal central apnea was not seen; in 3/103 seizures (3%), ICA persisted into the postictal period. ICA is a frequent, self-limiting semiological feature of focal epilepsy, often starting before surface EEG onset, and may be the only clinical manifestation of focal seizures. However, prolonged ICA (≥60 s) is associated with severe hypoxemia and may be a potential SUDEP biomarker. ICA is more frequently seen in temporal than extratemporal seizures, and in typical temporal seizure semiologies. ICA rarely persists after seizure end. ICA agnosia is typical, and thus it may remain unrecognized without polygraphic measurements that include breathing parameters.

Prospective Studies

Humans

Male

Seizures - diagnosis

Apnea - physiopathology

Incidence

Seizures - physiopathology

Apnea - diagnosis

Seizures - epidemiology

Female

Electroencephalography - trends

Death, Sudden - prevention & control

Apnea - epidemiology

Details

Title: Subtitle: The incidence and significance of periictal apnea in epileptic seizures
Creators: Nuria Lacuey - Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
Bilal Zonjy - 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
Anita Zaremba - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Rup K Sainju - University of Iowa School of Medicine, Iowa City, IA, USA
Brian K Gehlbach - University of Iowa School of Medicine, Iowa City, IA, USA
Stephan Schuele - Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Daniel Friedman - NYU Langone School of Medicine, New York, NY, USA
Orrin Devinsky - NYU Langone School of Medicine, New York, NY, USA
Maromi Nei - Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
Ronald M Harper - Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
Luke Allen - Institute of Neurology, University College London, London, UK
Beate Diehl - Institute of Neurology, University College London, London, UK
John J Millichap - Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
Lisa Bateman - Department of Neurology, Columbia University, New York, NY, USA
Mark A Granner - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Deidre N Dragon - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
George B Richerson - University of Iowa School of Medicine, Iowa City, IA, USA
Samden D Lhatoo - NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
Resource Type: Journal article
Publication Details: Epilepsia (Copenhagen), Vol.59(3), pp.573-582
DOI: 10.1111/epi.14006
PMID: 29336036
PMCID: PMC6103445
NLM abbreviation: Epilepsia
ISSN: 0013-9580
eISSN: 1528-1167
Publisher: United States
Grant note: U01 NS090415 / NINDS NIH HHS U01 NS090405 / NINDS NIH HHS U01 NS090407 / NINDS NIH HHS U01 NS090414 / NINDS NIH HHS
Language: English
Date published: 03/2018
Academic Unit: Neurology; Molecular Physiology and Biophysics; Pulmonary, Critical Care, and Occupational Medicine; Iowa Neuroscience Institute; Neurosurgery; Internal Medicine
Record Identifier: 9984013201702771

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