Authors :
Laura Vilella Bertran, MD – UT Health Science Center at Houston; Christina Miyake, MD, MS – Texas Children's Hospital; Chaitanya Ganne, MD, PhD – UT Health Science Center at Houston; Johnson Hampson, MBSME – UT Health Science Center at Houston; Norma Hupp, REEGT – UT Health Science Center at Houston; Shirin Omidi, MD – UT Health Science Center at Houston; Manuela Ochoa-Urrea, MD – UT Health Science Center at Houston; Jaison Hampson, MBBS – UT Health Science Center at Houston; MR Sandhya Rani, PhD – UT Health Science Center at Houston; Shiqiang Tao, PhD – UT Health Science Center at Houston; Nuria Lacuey, MD, PhD – UT Health Science Center at Houston; Daniel Friedman, MD – NYU School of Medicine; Brian Gehlbach, MD – University of Iowa; Catherine Scott, MS – University College London; Jennifer Ogren, PhD – UT Health Science Center at Houston; Rup Sainju, MBBS – University of Iowa; Guo-Qiang Zhang, PhD – UT Health Science Center at Houston; Ronald Harper, PhD – UCLA; Maromi Nei, MD – Thomas Jeffrson University; Lisa Bateman, MD – Columbia University; Beate Diehl, MD, FRCP – University College London; Stephan Schuele, MD – Northwestern University; Orrin Devinsky, MD – NYU School of Medicine; George Richerson, MD, PhD – University of Iowa; Samden D Lhatoo, MD, FRCP – UT Health Science Center at Houston
This abstract has been invited to present during the Neurophysiology platform sessionRationale: To analyze the prevalence of CA during GCS peri-ictal period, and its association with electroclinical characteristics and potential seizure severity biomarkers, including PGES, peri-ictal central apnea and hypoxemia.
Methods: Prospective analysis of VEEG recordings of GCS in patients admitted in adult EMUs. Demographic and clinical data were collected, including treatment with LTG, LCM, CBZ and PHT. Semiological and cardiorespiratory features were analyzed through VEEG, EKG, thoraco-abdominal bands and pulsi oximetry when available. Two minutes before clinical or electrographic seizure onset (pre-ictal period), the ictal period (limited to the available technically satisfactory portions of the recording) and up to 3 minutes after clinical seizure end (post-convulsive period) were visually analyzed. In all 3 periods, we investigated the presence of sinus tachycardia (>100 bpm), sinus bradycardia ( < 60 bpm), asystole (RR interval ≥ 3 s), supraventricular tachyarrhythmias (SVT), premature atrial beats, premature ventricular beats (PVC), non-sustained ventricular tachycardia (NSVT, ≥3 consecutive PVC at >100 bpm), ventricular fibrillation and atrioventricular block. Exaggerated sinus arrhythmia (ESA) was defined by variations in the sinus rhythm without apparent correlation with the breathing pattern, and exaggerated sinus arrhythmia with bradycardia (ESAWB), if at least one RR interval was >1 s (and ≤ 3 s) for < 3 consecutive beats. Presence of CA was classified with any of the aforementioned cardiac patterns, except for sinus tachycardia. If multiple CA types were recorded in the same period, all types were collected. Statistical analysis using GEE was performed in order to establish possible associations between electroclinical variables and the occurrence of seizure induced (ictal or postconvulsive) clinically significant CA (bradycardia, asystole, SVT, NSVT, VF, AVB and ESAWB).
Results: A total of 455 seizures in 249 patients [137 (55%) female] were include
d. Pre-ictal CA was noted in 76/436 (17.4%) seizures in 68/241 (28.1%) patients: in 70/436 (16.1%) seizures in 64/241 patients, only 1 CA type was noted. In 6 (1.4%) seizures in 5/241 patients, 2 pre-ictal CA types were noted. Ictal CA was noted in 48/424 (11.3%) seizures in 44/237 (18.6%) patients: 44/424 (10.4%) seizures (40/237 patients) had only 1 CA type, whereas in 4/424 (0.9%) seizures (4/237 patients) 2 pre-ictal CA types were seen. Post-convulsive CA was noted in 254/400 (63.5%) seizures in 164/229 (71.6%) patients: 200/400 (50%) seizures (134/229 patients) had only 1 CA type and 54/400 seizures had ≥ 2 CA types. CA types frequency is shown in Table 1. The commonest seizure-related CA was ESA. The commonest clinically significant CA were ESAWB and SVT. No associations between clinically significant CA and seizure severity biomarkers was found.
Conclusions: Dangerous CA are uncommon and usually self-limited. ESA is the most frequent seizure-related CA, and unlikely to be deleterious by itself, indicating enhanced vagal tone. Markers of seizure severity do not appear to relate to clinically significant CA occurrence, suggesting that these are not co-dependent.
Funding: NIH/NINDS U01-NS090405 and NIH/NINDS U01-NS090407