Association Between Semiologic, Autonomic and Electrographic Seizure Characteristics in Children with Generalized Tonic-Clonic Seizures
Abstract number :
3.102
Submission category :
2. Translational Research / 2C. Biomarkers
Year :
2021
Submission ID :
1825778
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:50 AM
Authors :
Sarah Cantley, BA - Boston Children's Hospital; Rima El Atrache, MD - Boston Children's Hospital; Eleonora Tamilia, PhD - Boston Children's Hospital; Marta Amengual-Gual, MD - Boston Children's Hospital; Fatemeh Mohammadpour Touserkani, MD - Boston Children's Hospital; Yonghua Yang, MD - the First Affiliated Hospital of Xi’an Jiaotong University; Xiaofan Wang, PhD - Boston Children's Hospital; Claire Ufongene, BA - Boston Children's Hospital; Theodore Sheehan, BS - Boston Children's Hospital; Michele Jackson, BA - Boston Children's Hospital; Bo Zhang, PhD - Boston Children's Hospital; Christos Papadelis, PhD - Boston Children's Hospital; Rani Sarkis, MD, MS - Brigham and Women's Hospital; Tobias Loddenkemper, MD - Boston Children's Hospital
Rationale: Generalized Tonic-Clonic Seizures (GTCS) are associated with elevated postictal Electrodermal Activity (EDA) and Postictal Generalized EEG Suppression (PGES), which are potential markers for Sudden Unexpected Death in Epilepsy (SUDEP) risk. This study investigates the association of GTCS semiologic characteristics, EDA, and PGES in children with epilepsy.
Methods: We enrolled patients admitted to the long-term video EEG monitoring unit at Boston Children’s Hospital, and asked patients to wear a portable wrist or ankle sensor that records EDA. We selected patients with at least one GTCS of focal or generalized onset during enrollment. Two independent, board-certified epileptologists reviewed video-EEG to collect semiologic characteristics, duration of tonic and clonic phases, total clinical seizure duration, electrographic seizure onset and offset, and PGES. Based on tonic presentation preceding four-limb clonic jerking, we grouped patients into three semiology classes: GTCS 1 with bilateral symmetric tonic arm extension; GTCS 2 with no specific tonic arm extension or flexion; GTCS 3 with unilateral or asymmetrical arm extension, tonic arm flexion or posturing, or a presentation that does not fit into GTCS 1 or GTCS 2. We analyzed the correlation between semiology and EDA; semiology and PGES; and EDA and PGES. Using MATLAB, we analyzed the area under the curve (AUC) of ictal EDA. We calculated the seizure-induced EDA change by subtracting ictal EDA (using a 60-minute EDA signal beginning at seizure onset) from baseline EDA (using a 60-minute seizure-free segment before seizure onset). Using linear regression, we analyzed the first GTCS the patient had during the recording, adjusting for sleep and awake.
Results: Thirty patients (median age 13.8 ± 3.6 years, 46.7% females) met our inclusion criteria. GTCS 1 showed greater EDA change than GTCS 2 (p= 0.047). PGES presence (p= 0.01) correlated with a higher EDA. GTCS 1 patients had longer PGES duration as compared to GTCS 2 (p < 0.001) and GTCS 3 (p= 0.016) patients. In the absence of PGES, GTCS semiology subtype was not associated with EDA changes. Other seizure characteristics did not correlate with EDA change or PGES duration, including tonic phase duration, clonic phase duration, and total seizure duration. EDA change and PGES duration did not differ between seizures that occurred out of awake and asleep states.
Conclusions: In children with epilepsy, GTCS subtype semiology presenting with bilateral and symmetrical tonic arm extension correlated with longer PGES duration and may indirectly correlate with greater ictal EDA. Our study suggests potential applications of GTCS subtype, PGES duration, and EDA AUC in pediatric seizures, and potentially SUDEP risk assessment. Further research is needed to validate our findings.
Funding: Please list any funding that was received in support of this abstract.: This study was funded by ERF.
Translational Research