Postictal immobility and generalized <scp>EEG</scp> suppression are associated with the severity of respiratory dysfunction

Kuo, Jen-Tsai; Zhao, Weina; Li, Chin‐Shang; Kennedy, Jeffrey D.; Seyal, Masud

doi:10.1111/epi.13312

Cited by 73 publications

(100 citation statements)

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“…In a review of 9 published studies comprising 542 patients, it was shown that the percentage of focal seizures during REM sleep is extremely low, being around 1%. 22 Of note, similar to our findings, 13 Alexandre and colleagues 15 found a correlation between the occurrence of PGES, but not PGES duration, for any patient or seizure variables studied, and PGES occurrence was significantly increased when GTCS occurred in sleep. However, total seizure duration was shorter and no difference in the duration of the tonic phase was observed in seizures starting in sleep compared to those starting during wakefulness.…”

Section: Epilepsia Ilaesupporting

confidence: 88%

“…13 Although PGES occurs more frequently in sleep, the duration of PGES is not influenced by the state of the patient. 13 Although PGES occurs more frequently in sleep, the duration of PGES is not influenced by the state of the patient.…”

Section: Epilepsia Ilaementioning

confidence: 99%

“…9,10 The relevance of PGES to SUDEP remains controversial. 13 PGES is correlated with the duration of postictal immobility, and both the duration of postictal immobility and presence of PGES are associated with periictal respiratory dysfunction. 12 Postictal immobility may be relevant in the pathophysiology of SUDEP.…”

mentioning

confidence: 97%

“…11 Approximately one third of seizures are associated with hypoxemia and hypercapnia that may be severe. 13,14 There was no direct analysis of peri-ictal oxygen desaturation and postictal immobility on PGES in a recent study demonstrating that PGES occurred more frequently following GTCS in sleep than wakefulness. 13 PGES is correlated with the duration of postictal immobility, and both the duration of postictal immobility and presence of PGES are associated with periictal respiratory dysfunction.…”

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confidence: 99%

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Postictal generalized EEG suppression and respiratory dysfunction following generalized tonic–clonic seizures in sleep and wakefulness

2017

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PGES occurs more commonly after GTCS in sleep than in wakefulness but, in the epilepsy-monitoring unit (EMU), a patient's state at seizure onset does not affect the degree of respiratory dysfunction or duration of postictal immobility. In sleep, outside the hospital setting, GTCS are likely to go unnoticed. Postictal immobility in prone patients prevents head repositioning and unimpeded air exchange. A positive feedback cycle ensues with increasing respiratory distress, potentiating postictal immobility and PGES and eventually leading to asystole. Our findings suggest that the high incidence of nocturnal SUDEP may be related to the unsupervised environment during sleep rather than the severity of sleep-related respiratory dysfunction or PGES duration in the immediate postictal period.

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Section: Epilepsia Ilaesupporting

confidence: 88%

Section: Epilepsia Ilaementioning

confidence: 99%

mentioning

confidence: 97%

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confidence: 99%

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Postictal generalized EEG suppression and respiratory dysfunction following generalized tonic–clonic seizures in sleep and wakefulness

2017

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“…Postictal immobility, presumed to reflect depressed arousal and/or motor function 19,20 , is commonly observed after FBTCS and has been associated with postictal EEG attenuation in scalp recordings. Interestingly, the timing of postictal immobility with respect to IPA was highly variable.…”

Section: Discussionmentioning

confidence: 99%

Postictal clinical and electroencephalographic activity following intracranially recorded bilateral tonic–clonic seizures

et al. 2018

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Summary Objective: The dynamics of the postictal period, which may demonstrate such dramatic clinical phenomena as focal neurological deficits, prolonged coma and immobility, and even sudden death, are poorly understood. We sought to classify and characterize postictal phases of bilateral tonic-clonic seizures based on EEG criteria and associated clinical features. Methods: We performed a detailed electroclinical evaluation of the postictal period in a series of 31 bilateral tonic-clonic seizures in 16 patients undergoing epilepsy surgery evaluations for focal pharmacoresistant epilepsy with intracranial electrodes and time-locked video. Results: The postictal EEG demonstrated three clearly differentiated phases: attenuation, a burst-attenuation pattern, and a return to continuous background, with abrupt, synchronized transitions between phases. Postictal attenuation was common, occurring in 84% of seizures in 94% of patients in this study. There was increased power in gamma frequencies (> 25 Hz) during postictal attenuation periods relative to preictal baseline in 88% of seizures demonstrating the attenuation pattern (N=25 seizures, p<0.002). Such increases were seen in more than 90% of channels in 13 seizures (52%), and fewer than 10% of channels in three seizures (12%). Postictal immobility was seen in 87% of seizures, with either a flaccid (58%) or rigid/dystonic (29%) appearance. Clinical motor manifestations, including focal dystonic posturing, automatisms, head and eye deviation, and myoclonic jerking, continued or emerged within the first minute following seizure termination in 48% of seizures, regardless of EEG appearance. Significance: Intracranial postictal attenuation, which may be diffuse or focal, is so common that it should be regarded as an ubiquitous feature of bilateral tonic-clonic seizures, rather than an unusual event. The prominence of high frequency activity coupled with emerging clinical features, including rigid immobility and semiologies such as automatisms, during the postictal period support the presence of ongoing seizure-related neuronal activity in unrecorded brain regions.

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Semiology of spontaneous generalized tonic‐clonic seizures in the epileptic baboon

2020

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Objective:The epileptic baboon provides an animal model for juvenile myoclonic epilepsy (JME), demonstrating spontaneous generalized tonic-clonic seizures (GTCS) in addition to generalized myoclonic, absence and multifocal seizures.While photoconvulsive responses have been described in this model, spontaneous GTCS have not been characterized. Methods: In this study, we characterized 46 seizures in 7 epileptic baboons (5 females, 12 ± 3 years old) by video recording. While housed in single cages, the baboons were monitored for a median of 2 (range 1-10) weeks, with high-resolution, infrared-capable camera systems. Each GTCS was evaluated for evidence of preconvulsive ictal symptoms, focal convulsive behaviors, duration of the preconvulsive and convulsive periods, postictal immobility, and recovery of an upright posture. The circadian pattern of GTCS was also for each baboon. Results: More than half of GTCS occurred in sleep, beginning from an upright position in all but one tethered baboon. Focal semiological findings were noted in 19 (41%) GTCS, and these included preconvulsive focal ictal motor behaviors as well as lateralized motor activity during the convulsions. The convulsive portion lasted 47 ± 10 seconds, whereas the entire seizure lasted 54 ± 21 seconds. Postictally, the baboons remained immobile for a median latency of 40 (range 14-347) seconds, recovering an upright posture after 173 (range 71-1980) seconds. GTCS demonstrated circadian patterns in all but one baboon, with 34 (74%) all seizures occurring between 1-9 am. Significance: GTCS in the baboon revealed intersubject variability, but semiology remained stereotyped in a given baboon. Similar to GTCS in people with JME, focal symptoms were also observed in epileptic baboons. The postictal recovery period, characterized by postictal immobility and myoclonus as well as time to recumbency, also varied among baboons. K E Y W O R D Sanimals models, baboon, generalized tonic-clonic seizures, Idiopathic Generalized Epilepsy, SUDEP 214 | SZABO et Al.

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Postictal immobility and generalized EEG suppression are associated with the severity of respiratory dysfunction

Cited by 73 publications

References 24 publications

Postictal generalized EEG suppression and respiratory dysfunction following generalized tonic–clonic seizures in sleep and wakefulness

Postictal generalized EEG suppression and respiratory dysfunction following generalized tonic–clonic seizures in sleep and wakefulness

Postictal clinical and electroencephalographic activity following intracranially recorded bilateral tonic–clonic seizures

Semiology of spontaneous generalized tonic‐clonic seizures in the epileptic baboon

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