Ictal central apnea (ICA) is a frequent, self-limiting semiological feature of focal epilepsy, often starting before surface electroencephalogram (EEG) onset, according to a recent study, and may be the only clinical manifestation of focal seizures. However, prolonged ICA (≥60 s) is associated with severe hypoxemia and may be a potential sudden unexpected death in epilepsy (SUDEP) biomarker. Researchers prospectively studied polygraphic physiological responses, including inductance plethysmography, peripheral capillary oxygen saturation (SpO2), electrocardiography, and video electroencephalography (VEEG) in 473 patients in a multicenter study of SUDEP. They found:
- Complete datasets were available in 126 patients in 312 seizures.
- ICA occurred exclusively in focal epilepsy (51/109 patients [47%] and 103/312 seizures [36.5%]).
- ICA was the only clinical manifestation in 16/103 (16.5%) seizures, and preceded EEG seizure onset by 8 ± 4.9 s, in 56/103 (54.3%) seizures.
- ICA ≥60 s was associated with severe hypoxemia (SpO2 <75%).
- Temporal lobe epilepsy was highly associated with ICA in comparison to extratemporal epilepsy and frontal lobe epilepsy.
- Isolated postictal central apnea was not seen; in 3/103 seizures (3%), ICA persisted into the postictal period.
Lacuey N, Zonjy B, Hampson JP, et al. The incidence and significance of periictal apnea in epileptic seizures. [Published online ahead of print January 16, 2018]. Epilepsia. doi:10.1111/epi.14006.
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