Ictal hypoxemia: A systematic review and meta-analysis

Abstract

A B S T R A C TPurpose: To estimate the incidence of ictal hypoxemia (IH) and to identify clinical and study-related factors modulating the estimate. Methods: We searched articles recording concurrent peri-ictal and ictal EEG and Sp02 in adults and children with epilepsy. Studies reporting the total number of seizures recorded and the number of seizures with IH were included in a random-effects meta-analysis. A random-effects meta-regression was used to identify variables affecting study heterogeneity. Results: Twenty-one studies, including 917 participants and 1840 with SpO2 data available were included. The meta-analysis showed a pooled incidence of IH of 35/100 seizures (95% CI 27-44). Sp02 desaturation threshold was associated with the incidence of IH, with less severe desaturations resulting in higher IH frequencies. The incidence of IH was 41/100 seizures (95% CI 29-54) for adults and 47/100 seizures (95% CI 15-78) for tonicclonic seizures. The meta-regression showed that SpO2 desaturation severity was the sole variable significantly correlated with the incidence of ictal hypoxemia (p = 0.00). Conclusion: In a population with refractory epilepsy IH is a frequent phenomenon, especially in adults and in patients presenting with tonic-clonic seizures. The severity of IH appeared independent from the age group and from seizure type and is probably the major clinical concern for its correlation with potentially life-threatening cardiorespiratory alterations and sudden unexpected death in epilepsy (SUDEP). factors on its occurrence, severity, duration and association with apnea https://doi.

The Magnitude of Postconvulsive Leukocytosis Mirrors the Severity of Periconvulsive Respiratory Compromise: A Single Center Retrospective Study

“…The results of this investigation are consistent with previously published rates of periconvulsive respiratory anomalies (34), postictal leukocytosis (1, 2), periconvulsive endotracheal intubations (30), and postconvulsive CXR findings (19). Moreover, our results revealed a high incidence of anemia in our study population, a finding reminiscent of a previously reported negative correlation between the frequency of epileptic seizures and hemoglobin levels (35).…”

Apnea Associated with Brainstem Seizures inCacna1aS218LMice Is Caused by Medullary Spreading Depolarization

“…Only nonfatal seizures with VLM SD were associated with apnea. We are unaware of descriptions of prolonged apnea during and following nonfatal seizures in other animal models, although in clinical epilepsy hypoxemia is common (Bruno et al, 2018). Other than respiratory effects, nonfatal seizures with brainstem SD could be discriminated from other nonfatal seizures by post-ictal ECoG suppression and increased HRV.…”

“…Seizure-related apnea occurs commonly in patients with epilepsy and can result in severe hypoxemia (Nashef et al, 1996;Bruno et al, 2018;Vilella et al, 2019). If prolonged, apnea may be fatal, as such apnea preceded cardiac arrest in rarely monitored cases of "sudden unexpected death in epilepsy" (SUDEP; Ryvlin et al, 2013), a fatal complication of epilepsy affecting patients of all ages (Massey et al, 2014;Devinsky et al, 2016;Harden et al, 2017).…”

Patients' experience of wearing multimodal sensor devices intended to detect epileptic seizures: A qualitative analysis

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