Postictal generalized EEG suppression is linked to seizure-associated respiratory dysfunction but not postictal apnea
Postictal generalized EEG suppression is linked to seizure-associated respiratory dysfunction but not postictal apnea
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DOI：
10.1111/j.1528-1167.2012.03443.x
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发表时间：
2012-05-01
期刊：
影响因子：
5.6
通讯作者：
Bateman, Lisa M.
中科院分区：
文献类型：
--
作者：
Seyal, Masud;Hardin, Kimberly A.;Bateman, Lisa M.
目的：癫痫发作后全身性脑电图（EEG）抑制（PGES）与癫痫猝死（SUDEP）的关系存在争议。已表明PGES与导致SUDEP的呼吸抑制相关，但PGES与呼吸抑制之间的关系尚不清楚。癫痫发作后呼吸频率和气流幅度增加，但存在持续性高碳酸血症和低氧血症。为了确定PGES癫痫发作是否会导致呼吸功能障碍，我们分析了定位相关癫痫患者视频脑电图遥测期间记录的呼吸参数。研究方法：其次，全身性惊厥发作（GC）与PGES头皮脑电图或双侧发作后衰减（BA）颅内记录进行了比较，GC没有PGES/BA。比较了GC伴或不伴PGES/BA组的氧饱和度下降最低值和持续时间、潮气末CO2（ETCO 2）、呼吸暂停持续时间、癫痫发作持续时间和惊厥成分持续时间。主要发现：GC + PGES/BA组（n = 30）和GC + PGES/BA组（n = 72）的总发作持续时间和惊厥持续时间无显著差异。GC联合PGES/BA的平均氧饱和度下降最低值为68.8 +/- 11.8%（71.5，4388）（平均值+/-标准差[中位数，范围]），低于（p = 0.002）未联合PGES/BA的癫痫发作（76.31 +/- 10.17% [79，4293]）。PGES/BA组去氧饱和持续时间明显延长，ETCO 2峰值明显升高。呼吸暂停持续时间无差异。在PGES/BA期间没有出现呼吸暂停，在有或没有PGES/BA的GC中，呼吸暂停通常不会延长到发作后期。重要性：PGES与发作后中枢性呼吸暂停无关，但更可能与呼吸相关的内源性肺功能障碍的严重程度有关。
Purpose: The relationship of postictal generalized electroencephalography (EEG) suppression (PGES) with sudden unexpected death in epilepsy (SUDEP) is controversial. It has been suggested that PGES is associated with respiratory inhibition leading to SUDEP, but the relationship between PGES and respiratory depression is unknown. Respiratory rate and amplitude of airflow increase following seizures but there is persistent hypercapnia and hypoxemia. To determine whether seizures with PGES result in respiratory dysfunction, we analyzed respiratory parameters recorded during video-EEG telemetry in patients with localization-related epilepsy. Methods: Secondarily generalized convulsive seizures (GC) with PGES on scalp EEG or bilateral postictal attenuation (BA) on intracranial recordings were compared to GC without PGES/BA. Oxygen desaturation nadir and duration, end-tidal CO2 (ETCO2), apnea duration, and duration of the seizure and of the convulsive component were compared in GC with or without PGES/BA. Key Findings: There was no significant difference between GC with (n = 30) or without PGES/BA (n = 72) for total seizure duration or duration of the convulsion. GC with PGES/BA had a mean oxygen desaturation nadir of 68.8 +/- 11.8% (71.5, 4388) (mean +/- standard deviation [median, range]) that was lower (p = 0.002) than seizures without PGES/BA (76.31 +/- 10.17% [79, 4293]). The duration of desaturation was significantly longer and peak ETCO2 higher in GC with PGES/BA. There was no difference in apnea duration. Apnea did not start during PGES/BA and did not typically extend into the postictal period in GC with or without PGES/BA. Significance: PGES is not associated with postictal central apnea but is more likely related to the severity of seizure-associated intrinsic pulmonary dysfunction.