Seizure Clusters, Seizure Severity Markers, and SUDEP Risk.
Seizure Clusters, Seizure Severity Markers, and SUDEP Risk.
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DOI：
10.3389/fneur.2021.643916
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发表时间：
2021
影响因子：
3.4
通讯作者：
Lhatoo SD
中科院分区：
文献类型：
--
作者：
Ochoa-Urrea M;Lacuey N;Vilella L;Zhu L;Jamal-Omidi S;Rani MRS;Hampson JP;Dayyani M;Hampson J;Hupp NJ;Tao S;Sainju RK;Friedman D;Nei M;Scott C;Allen L;Gehlbach BK;Reick-Mitrisin V;Schuele S;Ogren J;Harper RM;Diehl B;Bateman LM;Devinsky O;Richerson GB;Zhang GQ;Lhatoo SD
依据：癫痫发作簇可能与癫痫意外猝死（SUDEP）有关。在MORTEMUS研究中，7/11例（64%）监测SUDEP的患者在视频脑电图期间捕获了两次或多次全身性惊厥发作（GCS）。因此，癫痫发作簇可能与癫痫严重程度相关，并可能与SUDEP风险相关。我们的目的是确定是否电临床癫痫发作的特点恶化，从癫痫发作到癫痫发作在一个集群和GCS集群之间的可能关联，癫痫发作严重程度的标志物，和SUDEP风险。方法：患者是一项多中心研究中连续的、前瞻性同意的耐药性癫痫参与者。癫痫发作簇定义为在癫痫监测单元（EMU）中记录长时间视频脑电图期间，24小时内出现两次或两次以上GCS。我们测量了心率变异性（HRV）、脉搏血氧饱和度、体积描记法、发作后广义脑电图抑制（PGES）和脑电图（EEG）恢复时间。使用线性混合效应模型研究首次和后续癫痫发作之间的差异，显著性水平设定为p < 0.05。结果：我们在105例285次癫痫发作中识别出112个GCS簇。GCS平均持续48.7 ± 19 s（平均49，范围2-137）。184次（64.6%）发作中出现PGES，38次（13.3%）发作中出现惊厥后中枢性呼吸暂停（PCCA）。从癫痫发作到癫痫发作的癫痫发作特征的变化，如癫痫发作和惊厥相持续时间似乎是随机的。在分组分析中，一些癫痫发作的功能进行了显着恶化，而其他改善。阵挛期和惊厥后中枢性呼吸暂停（PCCA）在第四次癫痫发作显着较短的第一次。相比之下，去大脑姿势和发作性中枢性呼吸暂停的持续时间较长。随访时报告了群集队列中的4例SUDEP病例。结论：癫痫发作簇性发作在不同的癫痫发作中表现出不同的变化。虽然群集可能反映癫痫的严重程度，但它们本身可能与SUDEP风险无关。我们认为SUDEP的发生具有随机性，如果SUDEP的潜在进展趋势已经成熟到临界SUDEP阈值，则癫痫发作簇可能更有可能导致SUDEP。
Rationale: Seizure clusters may be related to Sudden Unexpected Death in Epilepsy (SUDEP). Two or more generalized convulsive seizures (GCS) were captured during video electroencephalography in 7/11 (64%) patients with monitored SUDEP in the MORTEMUS study. It follows that seizure clusters may be associated with epilepsy severity and possibly with SUDEP risk. We aimed to determine if electroclinical seizure features worsen from seizure to seizure within a cluster and possible associations between GCS clusters, markers of seizure severity, and SUDEP risk. Methods: Patients were consecutive, prospectively consented participants with drug-resistant epilepsy from a multi-center study. Seizure clusters were defined as two or more GCS in a 24-h period during the recording of prolonged video-electroencephalography in the Epilepsy monitoring unit (EMU). We measured heart rate variability (HRV), pulse oximetry, plethysmography, postictal generalized electroencephalographic suppression (PGES), and electroencephalography (EEG) recovery duration. A linear mixed effects model was used to study the difference between the first and subsequent seizures, with a level of significance set at p < 0.05. Results: We identified 112 GCS clusters in 105 patients with 285 seizures. GCS lasted on average 48.7 ± 19 s (mean 49, range 2–137). PGES emerged in 184 (64.6%) seizures and postconvulsive central apnea (PCCA) was present in 38 (13.3%) seizures. Changes in seizure features from seizure to seizure such as seizure and convulsive phase durations appeared random. In grouped analysis, some seizure features underwent significant deterioration, whereas others improved. Clonic phase and postconvulsive central apnea (PCCA) were significantly shorter in the fourth seizure compared to the first. By contrast, duration of decerebrate posturing and ictal central apnea were longer. Four SUDEP cases in the cluster cohort were reported on follow-up. Conclusion: Seizure clusters show variable changes from seizure to seizure. Although clusters may reflect epilepsy severity, they alone may be unrelated to SUDEP risk. We suggest a stochastic nature to SUDEP occurrence, where seizure clusters may be more likely to contribute to SUDEP if an underlying progressive tendency toward SUDEP has matured toward a critical SUDEP threshold.
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影响因子：
5.6
作者：
Ferastraoaru, Victor;Schulze-Bonhage, Andreas;Haut, Sheryl R.
通讯作者：
Haut, Sheryl R.
影响因子：
5.6
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Shinnar, S
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作者：
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通讯作者：
French, Jacqueline