Incidence, Recurrence, and Risk Factors for Peri-ictal Central Apnea and Sudden Unexpected Death in Epilepsy
Incidence, Recurrence, and Risk Factors for Peri-ictal Central Apnea and Sudden Unexpected Death in Epilepsy
复制标题
DOI：
10.3389/fneur.2019.00166
复制
发表时间：
2019-03-01
影响因子：
3.4
通讯作者：
Lhatoo, Samden D.
中科院分区：
文献类型：
--
作者：
Vilella, Laura;Lacuey, Nuria;Lhatoo, Samden D.
前言：发作期呼吸功能障碍被认为是SUDEP的潜在机制。我们研究了发作期（伊卡）和惊厥后中枢性呼吸暂停（PCCA）的发病率和危险因素，以及它们与潜在的癫痫严重程度生物标志物（即，例如，方法：前瞻性，多中心癫痫监测研究的自主神经，呼吸生物标志物的SUDEP在成人顽固性癫痫和监测癫痫发作。分析了视频EEG、胸腹偏移、毛细血管血氧饱和度和心电图。亚组分析确定了记录≥ 2次癫痫发作患者的伊卡和PCCA复发率。我们排除了癫痫持续状态和模糊/不可用的视频。中枢性呼吸暂停（无胸腹式呼吸运动）定义为>= 1次呼吸缺失，且>= 5 s。伊卡是指非惊厥发作（NCS）前或沿着发生的呼吸暂停或全身性惊厥发作（GCS）前的呼吸暂停。83/192例（43.2%）患者的180/487次（36.9%）发作发生伊卡，均为局灶性癫痫。睡眠状态与伊卡的存在相关[RR 1.33，CI 95%（1.08-1.64），p = 0.008]，而颞外癫痫与ICA发生率较低相关伊卡ERR 0.58，CI 95%（0.37-0.90），p = 0.015]。45/60例（75%）患者伊卡复发。无论癫痫类型如何，30/134例（22.4%）患者的41/228例（18%）GCS发生PCCA。女性性别[RR 11.30，CI 95%（4.50-28.34），p < 0.001]和伊卡持续时间[RR 1.14，CI 95%（1.05-1.25），p = 0.001]与PCCA的存在相关，而PGES的缺失与PCCA的缺失相关[0.27，CI 95%（0.16-0.47），p < 0.001]。男性的PCCA持续时间较长[HR 1.84，CI 95%（1.06-3.19），p = 0.003]。在9/17（52.9%）的患者，PCCA是recurrent.Conclusion：伊卡的发病率几乎是PCCA的发病率的两倍，只看到局灶性癫痫，而不是PCCA，提示不同的病理生理。伊卡可能是一种反复发作的皮质癫痫放电的症状学现象，而PCCA可能是GCS后脑干功能障碍的反映。我们报告的两个病例证明，伊卡或PCCA延长可能分别导致SUDEP。需要进一步的前瞻性队列研究来验证这些假设。
Introduction: Peri-ictal breathing dysfunction was proposed as a potential mechanism for SUDEP. We examined the incidence and risk factors for both ictal (ICA) and post-convulsive central apnea (PCCA) and their relationship with potential seizure severity biomarkers (i. e., post-ictal generalized EEG suppression (PGES) and recurrence.Methods: Prospective, multi-center seizure monitoring study of autonomic, and breathing biomarkers of SUDEP in adults with intractable epilepsy and monitored seizures. Video EEG, thoraco-abdominal excursions, capillary oxygen saturation, and electrocardiography were analyzed. A subgroup analysis determined the incidences of recurrent ICA and PCCA in patients with >= 2 recorded seizures. We excluded status epilepticus and obscured/unavailable video. Central apnea (absence of thoracic-abdominal breathing movements) was defined as >= 1 missed breath, and >= 5 s. ICA referred to apnea preceding or occurring along with non-convulsive seizures (NCS) or apnea before generalized convulsive seizures (GCS).Results: We analyzed 558 seizures in 218 patients (130 female); 321 seizures were NCS and 237 were GCS. ICA occurred in 180/487 (36.9%) seizures in 83/192 (43.2%) patients, all with focal epilepsy. Sleep state was related to presence of ICA [RR 1.33, CI 95% (1.08-1.64), p = 0.008] whereas extratemporal epilepsy was related to lower incidence of ICA ERR 0.58, CI 95% (0.37-0.90), p = 0.015]. ICA recurred in 45/60 (75%) patients. PCCA occurred in 41/228 (18%) of GCS in 30/134 (22.4%) patients, regardless of epilepsy type. Female sex [RR 11.30, CI 95% (4.50-28.34), p < 0.001] and ICA duration [RR 1.14 CI 95% (1.05-1.25), p = 0.001] were related to PCCA presence, whereas absence of PGES was related to absence of PCCA [0.27, CI 95% (0.16-0.47), p < 0.001]. PCCA duration was longer in males [HR 1.84, CI 95% (1.06-3.19), p = 0.003]. In 9/17 (52.9%) patients, PCCA was recurrent.Conclusion: ICA incidence is almost twice the incidence of PCCA and is only seen in focal epilepsies, as opposed to PCCA, suggesting different pathophysiologies. ICA is likely to be a recurrent semiological phenomenon of cortical seizure discharge, whereas PCCA may be a reflection of brainstem dysfunction after GCS. Prolonged ICA or PCCA may, respectively, contribute to SUDEP, as evidenced by two cases we report. Further prospective cohort studies are needed to validate these hypotheses.