Periictal Cardiovascular Changes in Partial and Generalized Convulsive Seizures
Abstract number :
1.152
Submission category :
3. Neurophysiology / 3C. Other Clinical EEG
Year :
2021
Submission ID :
1826676
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Mojtaba Dayyani, MD - University of Texas Health Science Center at Houston; Shirin Jamal-Omidi, MD - Neurology resident, Neurology, University of Texas Health Science Center at Houston; Ping Zhu, PhD - Vivian L. Smith Department of Neurosurgery - University of Texas Health Science Center at Houston; Jaison Hampson, MD - Neurology - University of Texas Health Science Center at Houston; Johnson Hampson, MSc - Neurology - University of Texas Health Science Center at Houston; Laura Vilella, MD - Neurology - University of Texas Health Science Center at Houston; Manuela Ochoa-Urrea, MD - Neurology - University of Texas Health Science Center at Houston; M R Sandhya Rani, PhD - Neurology - University of Texas Health Science Center at Houston; Norma Hupp - Neurology - University of Texas Health Science Center at Houston; Nuria Lacuey, MD, PhD - Assistant Professor, Neurology, University of Texas Health Science Center at Houston; Samden Lhatoo, MD - Professor, Neurology, University of Texas Health Science Center at Houston
Rationale: The occurrence of postictal hypotension (PIH) has been described previously and labeled as a potential biomarker of SUDEP. However, little is still known about seizure-related alterations of cardiovascular indices and their relation to other autonomic modalities. Herein, we used an extensive multimodality approach to elucidate the modifications and patterns of cardiovascular and autonomic indices in patients with convulsive seizures and gain an in-depth insight into potential pathomechanisms of SUDEP.
Methods: Forty-two consecutive subjects were included in this prospective case series from September 2011, to December, 2017. Eligible participants were individuals with intractable epilepsy who had generalized or focal motor seizures and admitted for inpatient video-EEG monitoring for better seizure characterization and/or pre-surgical assessment with the presence of artifact free non-invasive continuous blood pressure monitoring for a prolonged period from the first day of admission ( > 20 h). Using the LabChart Pro 8 software, we assessed changes of systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP), heart rate (HR), cardiac output (CO), stroke volume (SV), total peripheral resistance (TPR), and respirations at three phases of convulsive seizures (pre-ictal, ictal, and postictal). Descriptive data are presented as mean ± standard deviation; non-parametric tests were used as appropriate for between-group analysis.
Results: Out of 811 consecutive patients with epilepsy, 15 patients with GCS (15 seizures) and 27 patients with focal seizure (51 seizures) fulfilled inclusion criteria and were included in the study. Three patients with GCS (20%) and six patients with focal seizure (22%) developed PIH (MAP< 65 mmHg). Among the cases with GCS and PIH, cardiac output and stroke volume reached their lowest level at the seizure end (P< 0.0001); but minimum levels were detected at the “tonic end” for those without PIH (P=0.08). TPR displayed a dramatic surge during the tonic phase of all cases with GCSs, and patients without PIH had the highest TPR values compared to the baseline (P=0.01). Likewise, picks detected in FSs, belonged to the patients without PIH and happened at the seizure end (P=0.004). Maximum value of TPR in GCSs was four times greater than the value in FSs. Among the cases with GCS, assessment of the association of seizure characteristics and SUDEP risk factors with PIH revealed that patients with younger age may be more prone to develop PIH (P= 0.009).
Conclusions: Periictal modifications of cardiovascular indices display distinct patterns with a more severe autonomic dysregulation in GCSs than FSs. Pre-ictal change in BP may predict autonomic changes in the postictal phase. Subjects with a younger age may be more prone to developing PIH in the context of GCSs. Multimodal evaluation of autonomic features is a potential approach for the possible premortem identification of patients most at risk of SUDEP. Conduction of larger studies is required for further justification of our findings and making robust clinical recommendations.
Funding: Please list any funding that was received in support of this abstract.: NINDS, Center for SUDEP Research’s Autonomic and Imaging Biomarkers (U01-NS090407).
Neurophysiology