Abstracts

Rationale: The risk of choking during a seizure (sz) can be a concern of physicians, people with epilepsy (PWE) and their families, particularly when sz are frequent and medically refractory. During diagnostic inpatient video-EEG monitoring (vEEG) for epilepsy, patients may have more frequent and severe sz than usual, possibly increasing the risk of complications such as aspiration. Anecdotally choking and aspiration during sz appear rare, however, there are no prior reports attempting to quantify the frequency of aspiration during vEEG. The objective of this study was to quantify to the risk of choking and aspiration during partial complex and generalized seizures. Methods: A retrospective chart review of PWE admitted for vEEG at Mayo Clinic Arizona from January 1, 2006 through December 31, 2007 with recorded partial complex (PC) or generalized tonic-clonic (GTC) sz was performed. A detailed review of the ictal video and EEG for each sz was performed. Patients admitted in status epilepticus or under age 18 years were excluded. Results: 381 sz in 93 patients were analyzed, consisting of 300 PC, 66 secondary GTC, and 15 primary GTC sz. There was a median of 2 sz per patient (range 1-26). Mean age was 42 years (range 18 to 86 years). Electrographic sz onset was generalized in 5%, partial temporal in 65%, and partial extra-temporal in 30%. Overall median sz duration was 65 seconds, with a mean duration of 99 seconds for PC and 118 seconds for secondary GTC sz. Supplemental oxygen (O2) was provided in 174 (46%) sz and oral suctioning in 86 (22.5%). In 46 (12%, 42/46 GTC) sz subjects were placed in the lateral decubitus position. With 22 (11.5%) sz there was a documented pulse oximetry of 89% or less in the postictal period. Of these 9 were PC and 13 were GTC. 21/22 received O2 and 15/22 oral suctioning. 59 events (15.5%) occurred during scheduled meal times,however patients were also allowed to snack/drink ad lib. 26 sz (6.8%) occurred while patients were actively eating or drinking, 10 with evidence of food in the mouth at onset. In only 1 of these was there any clinical suspicion for possible aspiration, but with no documented adverse pulmonary sequelae. In non-eating subjects, 3 sz (1 GTC, 2PC) were followed by postictal emesis. Postictal emesis was not demonstrably associated with hypoxia or aspiration. There were no cases of documented choking or aspiration pneumonia. Conclusions: Choking and aspiration during PC and GTC seizures appear to be rare, even when seizures occur while eating/drinking or are associated with emesis. It is uncertain if interventions such as oral suctioning, lateral decubitus positioning, or administration of oxygen reduce the risk of hypoxia or aspiration in PWE during vEEG monitoring.