Abstracts

Rationale: Apnea is a common event in babies and occurs for multiple reasons. As a manifestation of a seizure, apnea is rare and most often is associated with other signs (change in heart rate, blood pressure, pupillary dilatation) that raise clinical suspicion. The clinical seizures may be subtle and easily overlooked, and video-EEG may be required to demonstrate them. In infants, apnea is a common presentation of an apparent life threatening event (ALTE), and even less commonly results from a seizure than in neonates. Previous reports have proposed a temporal lobe/limbic system origin for ictal events associated with apnea, and have described hemorrhagic stroke as the most common finding in neonates with this presentation. Methods: We present four children, three neonates and one infant (two months old) referred to our center because of apneic spells. In all four, V-EEGs were performed for evaluation of apneic spells and demonstrated an ictal basis. Subtle clinical seizures accompanying the desaturation and apnea in the neonates were identified on review of the video and had been overlooked by the intensive care nursing staff. All four patients had temporal lobe-based seizures. Results: In all cases V-EEG demonstrated ictal events associated with apnea. All three neonates had sufficiently subtle seizures as to have been overlooked by intensive care nursing staff, and the apnea/desaturations were detected at or near the end of the seizures in 2/3 instances. Two neonates had a change in the heart rate (one increased, one decreased) associated with the seizures. The infant had oral automatisms and a characteristic cry at the onset of seizures. The three neonates were found to have hemorrhage (2) or infarct (1) involving the temporal lobe, and the infant had normal neuroimaging. Conclusions: When apnea is reported in a neonate or infant, a seizure should be considered if there is not another obvious explanation. The seizure associated with apnea may be subtle and overlooked, especially given the dramatic nature of the apnea, which may be clinically recognized as the seizure is ending. The temporal lobe/limbic system is most often involved in apneic seizures in the neonate and infant, and this helps explain the subtle nature of the seizures. V-EEG is a useful modality to determine the ictal nature of apnea in neonates and infants.