Periictal cerebral tissue hypoxemia: A potential marker of SUDEP risk
Periictal cerebral tissue hypoxemia: A potential marker of SUDEP risk
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DOI：
10.1111/j.1528-1167.2012.03707.x
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发表时间：
2012-12-01
期刊：
影响因子：
5.6
通讯作者：
So, Elson
中科院分区：
文献类型：
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作者：
Moseley, Brian D.;Britton, Jeffrey W.;So, Elson
在癫痫监测单元(EMU)中经历癫痫发作的患者中，脑氧饱和度测量尚未被探索。本研究的目的是评价无创性脑组织血氧测定仪在发作期测量脑氧合的可行性，并确定在全身性癫痫发作期间是否有脑低氧血症的证据。脑血氧饱和度结果随后与癫痫猝死(SUDEP)危险因素相关。我们前瞻性地评估了我们EMU收治的6名有全身性强直阵挛发作(GTCS)病史的患者，他们进行了长时间的头皮脑电(EEG)和两个局部脑氧饱和度(RSO2)传感器的检测。最低rSO2值出现在发作前5分钟、发作期间和发作解除后5分钟。使用SUDEP-7库存对SUDEP风险进行评估。脑血氧饱和度监测耐受性良好，平均rSO2监测时间为81.1h。在10次癫痫发作中，9次(90%)可从至少一个传感器获得脑血氧饱和度数据；10次癫痫发作中只有6次(60%)有可用的围绝经期数字脉搏血氧饱和度数据。GTC的最小发作时间(p=0.003)和发作后(p=0.004)%rSO2值均显著低于发作前最小值。至少有一次发作且%rSO2下降=20%的患者往往有更高的SUDEP-7问卷评分(平均SUDEP-7问卷评分7+/-2.8)，而没有记录的脱饱和度患者(4.3+/-0.5，p=0.08)。需要进行更大规模的研究来确定脑氧仪在识别有SUDEP风险的患者中的价值。
Cerebral oximetry has not been explored in patients experiencing seizures in the epilepsy monitoring unit (EMU). The purpose of our study was to evaluate the feasibility of periictal measurement of cerebral oxygenation using noninvasive cerebral tissue oximetry and to determine whether there was evidence of cerebral hypoxemia during generalized seizures. Cerebral oxygen saturation findings were subsequently correlated with sudden unexpected death in epilepsy (SUDEP) risk factors. We prospectively evaluated six patients admitted to our EMU with histories of generalized tonicclonic seizures (GTCS) with prolonged scalp electroencephalography (EEG) and two regional cerebral oxygen saturation (rSO2) sensors. Minimum rSO2 values were recorded in the 5 min preceding seizure onset, during the seizure, and in the 5 min following seizure offset. SUDEP risk was assessed using the SUDEP-7 Inventory. Cerebral oximetry was well tolerated, with a mean duration of rSO2 monitoring of 81.1 h. Cerebral oxygen saturation data were available from at least one sensor in 9 (90%) of 10 seizures; only 6 (60%) of 10 seizures had useable periictal digital pulse oximetry data. GTCS were associated with significantly lower minimum ictal (p = 0.003) and postictal (p = 0.004) %rSO2 values than the minimum preictal value. Patients with at least one seizure with a %rSO2 decrease of =20% tended to have higher SUDEP-7 Inventory scores (mean SUDEP-7 Inventory score 7 +/- 2.8) versus patients without recorded desaturations (4.3 +/- 0.5, p = 0.08). Larger studies are needed to determine the value of cerebral oximetry in the identification of patients at risk of SUDEP.