Incidence and Features of Persistent Post-ictal Central Apnea in Focal Seizures
Abstract number :
1.549
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2024
Submission ID :
1460
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Margherita Burani, MD – University of Modena and Reggio Emilia, Italy
Giada Giovannini, PhD – AOU Modena Academic Hospital
Alice Ballerini, PhD – University of Modena and Reggio Emilia
Elisa Micalizzi, MD – University of Modena and Reggio Emilia, Italy
Lisa Taruffi, MD – University of Modena and Reggio Emilia, Italy
Orlandi Niccolò, MD – University of Modena and Reggio Emilia
Matteo Pugnaghi, MD, PhD – AOU Modena
Anna Vaudano, PhD – University of Modena and Reggio Emilia, Italy
Presenting Author: stefano meletti, MD, PhD – University of Modena and Reggio Emilia, Italy
Rationale: Growing evidence suggests that post-convulsive central apnea is a major contributor to sudden unexplained death in epilepsy (SUDEP). Whether post-ictal apnea occurs exclusively after convulsive seizures or it can also result from focal self-limiting seizures is undetermined. Evaluating the incidence and characteristics of post-ictal central apnea (PICA) in focal seizures is crucial for enhancing our understanding of the neural mechanisms that lead to SUDEP.
Methods: We prospectively enrolled consecutive patients admitted to the Epilepsy Monitoring Unit at Modena Academic Hospital (Italy) from April 2020 to December 2023. Inclusion criteria for the present study were: (i) 14 years of age or older; (ii) at least one focal-onset seizure recorded during Video-EEG Long-term Monitoring (VLTM) with cardiorespiratory polygraphy; (iii) absence of tonic-clonic evolution.
Results: 69 patients (42% females; mean age 35.7 years) with 405 focal-onset seizures were analyzed. PICA was recorded in 12 patients (10 with TLE) in 23 seizures corresponding to 32.9% of seizures with ictal apnea (n=70) and to 5.7% of all recorded seizures. PICA was never observed in seizures/patients without ictal apnea. In 11 seizures with PICA a single apneic event starting in the ictal phase and extending to the postictal period was observed (see figure). In 12 seizures however, multiple apneic events were present in the postictal period (range 2 - 8). Seizure with PICA showed a longer peri-ictal apnea time than seizure with self-limiting ictal apnea (mean 74 sec vs 42 sec; p =0.024) and a longer time to restore the regular rhythmic breathing after seizure termination (mean 180 sec vs 46 sec; p = 0.0002). A significant correlation was present between apnea time and duration of oxygen desaturation (p < 0.001). In 15 out of 23 seizures with PICA the patients were actively interrogated by the EEG technologist during the postictal period and in every seizure the patient was not aware of the apnea. When the patient was awakened and/or had an interaction with the observer, normal respiratory pattern resumed. If the patient was left alone at rest instead, apneic events recurred before the reappearance of a regular rhythmic breathing pattern.
Neurophysiology