Pulse oximetry during apparent tonic-clonic seizures

Marshall, Hazel; Carew-McColl, M; James, Matthew R.

doi:10.1016/0140-6736(91)91168-t

Cited by 35 publications

(6 citation statements)

References 1 publication

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“…Many reports have confirmed what Jackson observed in 1899 (James et al, 1991; Watanabe et al, 1982). For example, Nashef (Nashef et al, 1996) used long term EEG monitoring and respiratory recordings to show that 10 of 17 patients (59%) had apnea concurrent with their seizures.…”

Section: Potential Pathophysiological Mechanisms In Sudepsupporting

confidence: 62%

Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

Sowers

Massey

Gehlbach

et al. 2013

Respiratory Physiology & Neurobiology

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Sudden unexplained death in epilepsy (SUDEP) is the cause of premature death of up to 17% of all patients with epilepsy and as many as 50% with chronic refractory epilepsy. However, SUDEP is not widely recognized to exist. The etiology of SUDEP remains unclear, but growing evidence points to peri-ictal respiratory, cardiac, or autonomic nervous system dysfunction. How seizures affect these systems remains uncertain. Here we focus on respiratory mechanisms believed to underlie SUDEP. We highlight clinical evidence that indicates peri-ictal hypoxemia occurs in a large percentage of patients due to central apnea, and identify the proposed anatomical regions of the brain governing these responses. In addition, we discuss animal models used to study peri-ictal respiratory depression. We highlight the role 5-HT neurons play in respiratory control, chemoreception, and arousal. Finally, we discuss the evidence that 5-HT deficits contribute to SUDEP and sudden infant death syndrome and the striking similarities between the two.

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Section: Potential Pathophysiological Mechanisms In Sudepsupporting

confidence: 62%

Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

Sowers

Massey

Gehlbach

et al. 2013

Respiratory Physiology & Neurobiology

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“…Since then, others have noted similar findings, and have documented apnea 10, 17 and oxygen desaturation 11-13 during and after seizures. Using long-term video-EEG monitoring and respiratory recordings, Nashef and colleagues 12 found that 10 of 17 patients (59%) developed apnea and 6 patients experienced oxygen desaturation (SaO 2 ) ranging from 55-83%, both concurrent with seizures 12 .…”

Section: Seizures and Respiratory Dysfunctionmentioning

confidence: 60%

“…2a), changes in blood pressure, and asystole, and this led to the assumption that SUDEP was due to a cardiac mechanism 8 . However, respiratory depression and apnea occuring during and after a seizure 9-11 have been well documented, and these abnormalities can be severe enough to cause oxygen desaturation (Fig. 2b) 12, 13 .…”

Section: Pathophysiologymentioning

confidence: 99%

Mechanisms of sudden unexpected death in epilepsy: the pathway to prevention

et al. 2014

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Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy, and yet many physicians do not know about this high risk of sudden death. It has been widely believed that SUDEP is due to cardiac abnormalities during the post-ictal period. However, recent studies have demonstrated that respiratory depression is common following a seizure, and can be severe enough to cause a substantial decrease in oxygen saturation. In this review we summarize evidence for cardiac, respiratory, and arousal abnormalities during the ictal and post-ictal period and potential mechanisms for these abnormalities. We discuss mouse models of seizure-induced death and how these models are useful for understanding the mechanisms that underlie SUDEP. Some of these are due to genetic mutations that have counterparts in human syndromes. Controversy remains regarding the relative importance of cardiac failure versus respiratory arrest as the primary cause of death. Resolving this controversy will require simultaneous monitoring of cardiac and respiratory parameters during cases of near SUDEP in humans and detailed pathophysiological data from animal models during seizure-induced death. Effective preventive strategies in high-risk patients will rely on defining the mechanisms that initiate the sequence of events that lead from seizures to death.

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“…Hypoventilation and hypoxemia are typically seen in focal to bilateral tonic clonic seizures (FBTCS) and generalized tonic clonic seizures (GTCS), 1, 23 and severe alteration of breathing patterns after such seizures has been suggested as a possible mechanism of Sudden Unexpected Death in Epilepsy (SUDEP) 1 . However, oxygen desaturations are also found in 30–60% of focal seizures without generalized convulsions 2 .…”

Section: Introductionmentioning

confidence: 99%

The incidence and significance of periictal apnea in epileptic seizures

Zonjy²,

et al. 2018

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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.

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Pulse oximetry during apparent tonic-clonic seizures

Cited by 35 publications

References 1 publication

Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

Mechanisms of sudden unexpected death in epilepsy: the pathway to prevention

The incidence and significance of periictal apnea in epileptic seizures

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