Abruptly Attenuated Terminal Ictal Pattern in Pediatrics

Kim, Andrew J.; Kuroda, Maxine M.; Nordli, Douglas R.

doi:10.1097/01.wnp.0000229045.28725.5c

Cited by 18 publications

(17 citation statements)

References 8 publications

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“…PGES occurs in between 8% of pediatric seizure patients (Kim et al 2006) to 65% or more of adult patients with GTCS (Lhatoo et al 2010) and has been reported in several monitored SUDEP/near SUDEP cases (Bateman et al 2010, Bird 1997, Lhatoo et al 2010, McLean & Wimalaratna 2007, So et al 2000, Tao et al 2010) where some authors have used the term “cerebral shutdown” (McLean & Wimalaratna 2007). The increased incidence and duration of PGES in adults is noteworthy as they are a higher risk population than children.…”

Section: Discussionmentioning

confidence: 99%

Age-specific periictal electroclinical features of generalized tonic–clonic seizures and potential risk of sudden unexpected death in epilepsy (SUDEP)

Freitas

Kaur

Fernandez

et al. 2013

Epilepsy & Behavior

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Generalized tonic-clonic seizures (GTCS) are the commonest seizure type associated with Sudden Unexplained Death in Epilepsy (SUDEP). This study examines semiological and electroencephalographic differences (EEG) in the GTCS of adults as compared to children. The rationale lies in epidemiological observations that have noted a ten-fold higher incidence of SUDEP in adults. We analyzed video-EEG data of 105 GTCS in 61 consecutive patients (12 children, 23 seizures and 49 adults, 82 seizures) recruited from the Epilepsy Monitoring Unit. Semiological, EEG and 3-channel EKG features were studied. Peri-ictal seizure phase durations were analyzed including tonic, clonic, total seizure, post-ictal EEG suppression (PGES) and recovery phases. Heart rate variability (HRV) measures including RMSSD (root mean square successive difference of R-R intervals), SDNN (standard deviation of NN intervals) and SDSD (standard deviation of differences) were analyzed (including low frequency/high frequency power ratios) during pre-ictal baseline, ictal and post-ictal phases. Generalized estimating equations (GEE) were used to find associations between electro-clinical features. Separate subgroup analyses were carried out on adult and pediatric age groups as well as medication groups (no anti-epileptic 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). GEE 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. PGES durations were on average 28 seconds shorter in children. With cessation of medication, total seizure duration was significantly increased by a mean value of 8 seconds in children and 11 seconds in adults (p<0.05). Tonic phase duration also significantly increased with medication cessation and although PGES durations increased, this was not significant. RMSSD 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 electro-clinical differences between adult and pediatric GTCS 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 electro-clinical markers of SUDEP risk and merit further study.

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Section: Discussionmentioning

confidence: 99%

Age-specific periictal electroclinical features of generalized tonic–clonic seizures and potential risk of sudden unexpected death in epilepsy (SUDEP)

Freitas

Kaur

Fernandez

et al. 2013

Epilepsy & Behavior

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“…The exact cause of the discrepancy is unclear, but children tend to have a lower prevalence of PGES (Kim et al, 2006;Semmelroch et al, 2012;Pavlova et al, 2013), shorter PGES durations, shorter tonic duration during their GTCS (Freitas et al, 2013), and a higher level of supervision at night (Thurman et al, 2014).…”

Section: Post-ictal Autonomic Changes In Adults Versus Pediatric Patimentioning

confidence: 94%

Autonomic changes following generalized tonic clonic seizures: An analysis of adult and pediatric patients with epilepsy

Sarkis¹,

Thomé‐Souza²,

Poh³

et al. 2015

Epilepsy Research

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“…The report by Verma et al [3] studied 13 patients with bilateral depth arrays and examined the side of termination in the context of outcome. A recent study of scalp patterns in children discusses an abruptly attenuated terminal ictal pattern which is synchronous termination, but this was more common in idiopathic and generalized seizures, a different population than has been studied elsewhere [7]. …”

Section: Introductionmentioning

confidence: 99%

Termination patterns of complex partial seizures: An intracranial EEG study

Afra

Jouny

Bergey

2015

Seizure

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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 partial seizures of both mesial temporal or neocortical onset. This may reflect stereotyped network behavior or dynamics at the seizure focus.

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Abruptly Attenuated Terminal Ictal Pattern in Pediatrics

Cited by 18 publications

References 8 publications

Age-specific periictal electroclinical features of generalized tonic–clonic seizures and potential risk of sudden unexpected death in epilepsy (SUDEP)

Age-specific periictal electroclinical features of generalized tonic–clonic seizures and potential risk of sudden unexpected death in epilepsy (SUDEP)

Autonomic changes following generalized tonic clonic seizures: An analysis of adult and pediatric patients with epilepsy

Termination patterns of complex partial seizures: An intracranial EEG study

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