| Title | Cardiorespiratory and autonomic function in epileptic seizures: A video-EEG monitoring study. | ||
| Author | Sivathamboo, Shobi; Constantino, Thomas N; Chen, Zhibin; Sparks, Paul B; Goldin, Jeremy; Velakoulis, Dennis; Jones, Nigel C; Kwan, Patrick; Macefield, Vaughan G; O'Brien, Terence J; Perucca, Piero | ||
| Journal | Epilepsy Behav | Publication Year/Month | 2020-Oct |
| PMID | 32653843 | PMCID | -N/A- |
| Affiliation + expend | 1.Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3000, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia; The Epilepsy Unit, Alfred Health, Melbourne 3004, Victoria, Australia; Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Parkville 3050, Victoria, Australia. Electronic address: Shobi.Sivathamboo@monash.edu. | ||
PURPOSE: Seizure-induced cardiorespiratory and autonomic dysfunction has long been recognized, and growing evidence points to its implication in sudden unexpected death in epilepsy (SUDEP). However, a comprehensive understanding of cardiorespiratory function in the preictal, ictal, and postictal periods are lacking. METHODS: We examined continuous cardiorespiratory and autonomic function in 157 seizures (18 convulsive and 139 nonconvulsive) from 70 consecutive patients who had a seizure captured on concurrent video-encephalogram (EEG) monitoring and polysomnography between February 1, 2012 and May 31, 2017. Heart and respiratory rates, heart rate variability (HRV), and oxygen saturation were assessed across four distinct periods: baseline (120鈥痵), preictal (60鈥痵), ictal, and postictal (300鈥痵). Heart and respiratory rates were further followed for up to 60鈥痬in after seizure termination to assess return to baseline. RESULTS: Ictal tachycardia occurred during both convulsive and nonconvulsive seizures, but the maximum rate was higher for convulsive seizures (mean: 138.8 beats/min, 95% confidence interval (CI): 125.3-152.4) compared with nonconvulsive seizures (mean: 105.4 beats/min, 95% CI: 101.2-109.6; p鈥?鈥?.001). Convulsive seizures were associated with a lower ictal minimum respiratory rate (mean: 0 breaths/min, 95% CI: 0-0) compared with nonconvulsive seizures (mean: 11.0 breaths/min, 95% CI: 9.5-12.6; p鈥?鈥?.001). Ictal obstructive apnea was associated with convulsive compared with nonconvulsive seizures. The low-frequency (LF) power band of ictal HRV was higher among convulsive seizures than nonconvulsive seizures (ratio of means (ROM): 2.97, 95% CI: 1.34-6.60; p鈥?鈥?.008). Postictal tachycardia was substantially prolonged, characterized by a longer return to baseline for convulsive seizures (median: 60.0鈥痬in, interquartile range (IQR): 46.5-60.0) than nonconvulsive seizures (median: 0.26鈥痬in, IQR: 0.008-0.9; p鈥?鈥?.001). For postictal hyperventilation, the return to baseline was longer in convulsive seizures (median: 25.3鈥痬in, IQR: 8.1-60) than nonconvulsive seizures (median: 1.0鈥痬in, IQR: 0.07-3.2; p鈥?鈥?.001). The LF power band of postictal HRV was lower in convulsive seizures than nonconvulsive seizures (ROM: 0.33, 95% CI: 0.11-0.96; p鈥?鈥?.043). Convulsive seizures with postictal generalized EEG suppression (PGES; n鈥?鈥?2) were associated with lower postictal heart and respiratory rate, and increased HRV, compared with those without (n鈥?鈥?). CONCLUSIONS: Profound cardiorespiratory and autonomic dysfunction associated with convulsive seizures may explain why these seizures carry the greatest risk of SUDEP.