Retrospective audit of postictal generalized EEG suppression in telemetry

Semmelroch, Mira; Elwes, Robert; Lozsádi, Dora A.; Nashef, Lina

doi:10.1111/j.1528-1167.2011.03296.x

Cited by 73 publications

(72 citation statements)

References 15 publications

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“…36 Meanwhile, in a study of 13 patients with PGES, these patients were significantly more likely to be motionless. 33 These findings were further confirmed in another case cohort of 64 patients, in which nearly all patients with PGES were comatose and unresponsive to verbal and physical stimulations for the duration of the PGES. 34 Accordingly, PGES is a likely EEG marker for impaired arousal in postictal patients.…”

Section: Resultsmentioning

confidence: 54%

“…It is rarely seen in patients with partial-onset seizures. 33,34 PGES has also been proposed as an EEG marker for SUDEP, because it is thought to reflect primary electrocerebral shutdown that can subsequently cause cardiorespiratory failure. In a study comparing 10 people who later died of SUDEP with 30 controls, the duration of PGES was significantly prolonged in SUDEP compared with non-SUDEP patients.…”

Section: Resultsmentioning

confidence: 99%

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Association of prone position with sudden unexpected death in epilepsy

et al. 2015

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Section: Resultsmentioning

confidence: 54%

Section: Resultsmentioning

confidence: 99%

Association of prone position with sudden unexpected death in epilepsy

et al. 2015

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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%

“…Patients with PGES tend to require more frequent nursing interventions (suctioning, oxygen, vital signs check) likely due to a higher level of concern about their post-ictal state and are more likely to remain motionless compared to controls (Semmelroch et al, 2012). The presence of PGES is also associated with longer periods of oxygen desaturation and higher end tidal CO 2 (Seyal et al, 2012).…”

Section: Pges and Autonomic Changesmentioning

confidence: 97%

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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“…Therefore, PGES may serve as a marker of postictal autonomic dysregulation, although how these parameters are pathophysiologically associated is unclear. In another study of 48 patients with generalized tonic-clonic seizures, 13 patients with PGES were compared to 12 random controls and one seizure analyzed per individual (21). Patients with PGES were significantly more likely to be motionless in the postictal period and to have simple resuscitative interventions performed (suction, oxygen administration, placed in recovery position, vital signs checked).…”

Section: Seizure Termination and The Postictal Statementioning

confidence: 99%

Seizures, Cerebral Shutdown, and SUDEP

Bozorgi

Lhatoo

2013

Epilepsy Curr

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In Clinical ResearchThere is strong evidence to suggest that sudden unexpected death in epilepsy (SUDEP) is a seizure-related phenomenon (1-5). The agonal pathophysiological processes in SUDEP are likely to begin during, or in the immediate aftermath of, a seizure. However, potential mechanisms are speculative. Epidemiological studies have consistently pointed to the generalized tonic-clonic seizure as the seizure type most commonly associated with SUDEP (6, 7), and almost all SUDEP reports of deaths during monitoring have occurred after generalized tonic-clonic seizures, (8-11) and often during sleep (3,12). This seizure type is associated with more severe obtundation of sensorium in the postictal period and can be associated with cardiorespiratory dysfunction during this time. Several questions arise: How do seizures terminate, and how do termination mechanisms relate to postictal arousal? Is the extent of obtundation and subsequent postictal arousal different in the frequent generalized tonic-clonic seizures of patients with chronic intractable epilepsy at high risk of SUDEP? Does postictal arousal differ according to the sleep-wake state at the time of seizure onset? Is postictal failure of arousal the same as the "cerebral shutdown" phenomenon seen on EEG? These questions remain unanswered. Seizure Termination and the Postictal StateThe generalized tonic-clonic seizure is usually characterized by generalized tonic posturing, a phase of tremulousness or "vibration" followed by a generalized clonic phase and, usually, seizure termination within the first 2 minutes of the clinical onset of generalization (13). In some genetic generalized epilepsies (e.g., juvenile myoclonic epilepsy), there may be generalized myoclonic jerking before the tonic phase; in secondarily generalized seizures, there may be a pretonic phase where version or "figure 4" posturing occurs. However, given this relative stereotypy, there is considerable clinical as well as electrographic heterogeneity in the postictal period (14, 15). Some patients recover quickly, while others have varying periods of postictal stupor. Some have brief periods of focal or generalized EEG slowing, while others have prolonged postictal generalized EEG suppression (PGES) and recovery to baseline can sometimes take many hours. Whether this postictal electroclinical heterogeneity aids SUDEP risk-stratification is debated (9, 16). Undoubtedly, there are a number of potential influences, including those of medication effects, but none have been systematically studied. Postictal Generalized EEG Suppression and "Cerebral Shutdown"PGES occurs in between 8% of pediatric seizure patients (17) to 65% or more of adult patients with generalized motor seizures (9) and has been reported in several monitored SUDEP/near SUDEP cases (8-11, 18, 19) where some authors have used the term "cerebral shutdown" (19). Prolonged PGES may be an independent risk factor for SUDEP, but whether it is a surrogate marker or a direct index of cerebral and brainstem dysregulation is unclear. It...

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Retrospective audit of postictal generalized EEG suppression in telemetry

Cited by 73 publications

References 15 publications

Association of prone position with sudden unexpected death in epilepsy

Association of prone position with sudden unexpected death in epilepsy

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

Seizures, Cerebral Shutdown, and SUDEP

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