Cardiorespiratory and autonomic function in epileptic seizures: A video-EEG monitoring study
Seizure-induced cardiorespiratory and autonomic dysfunction has long been recognized, and growing evidence points to its implication in sudden unexpected death in epilepsy (SUDEP). However, a comprehensive understanding of cardiorespiratory function in the preictal, ictal, and postictal periods are...
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| Veröffentlicht in: | Epilepsy & behavior 2020-10, Vol.111, p.107271-107271, Article 107271 |
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| creator | Sivathamboo, Shobi Constantino, Thomas N. Chen, Zhibin Sparks, Paul B. Goldin, Jeremy Velakoulis, Dennis Jones, Nigel C. Kwan, Patrick Macefield, Vaughan G. O'Brien, Terence J. Perucca, Piero |
| description | Seizure-induced cardiorespiratory and autonomic dysfunction has long been recognized, and growing evidence points to its implication in sudden unexpected death in epilepsy (SUDEP). However, a comprehensive understanding of cardiorespiratory function in the preictal, ictal, and postictal periods are lacking.
We examined continuous cardiorespiratory and autonomic function in 157 seizures (18 convulsive and 139 nonconvulsive) from 70 consecutive patients who had a seizure captured on concurrent video-encephalogram (EEG) monitoring and polysomnography between February 1, 2012 and May 31, 2017. Heart and respiratory rates, heart rate variability (HRV), and oxygen saturation were assessed across four distinct periods: baseline (120 s), preictal (60 s), ictal, and postictal (300 s). Heart and respiratory rates were further followed for up to 60 min after seizure termination to assess return to baseline.
Ictal tachycardia occurred during both convulsive and nonconvulsive seizures, but the maximum rate was higher for convulsive seizures (mean: 138.8 beats/min, 95% confidence interval (CI): 125.3–152.4) compared with nonconvulsive seizures (mean: 105.4 beats/min, 95% CI: 101.2–109.6; p |
| doi_str_mv | 10.1016/j.yebeh.2020.107271 |
| format | Article |
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We examined continuous cardiorespiratory and autonomic function in 157 seizures (18 convulsive and 139 nonconvulsive) from 70 consecutive patients who had a seizure captured on concurrent video-encephalogram (EEG) monitoring and polysomnography between February 1, 2012 and May 31, 2017. Heart and respiratory rates, heart rate variability (HRV), and oxygen saturation were assessed across four distinct periods: baseline (120 s), preictal (60 s), ictal, and postictal (300 s). Heart and respiratory rates were further followed for up to 60 min after seizure termination to assess return to baseline.
Ictal tachycardia occurred during both convulsive and nonconvulsive seizures, but the maximum rate was higher for convulsive seizures (mean: 138.8 beats/min, 95% confidence interval (CI): 125.3–152.4) compared with nonconvulsive seizures (mean: 105.4 beats/min, 95% CI: 101.2–109.6; p < 0.001). Convulsive seizures were associated with a lower ictal minimum respiratory rate (mean: 0 breaths/min, 95% CI: 0–0) compared with nonconvulsive seizures (mean: 11.0 breaths/min, 95% CI: 9.5–12.6; p < 0.001). Ictal obstructive apnea was associated with convulsive compared with nonconvulsive seizures. The low-frequency (LF) power band of ictal HRV was higher among convulsive seizures than nonconvulsive seizures (ratio of means (ROM): 2.97, 95% CI: 1.34–6.60; p = 0.008). Postictal tachycardia was substantially prolonged, characterized by a longer return to baseline for convulsive seizures (median: 60.0 min, interquartile range (IQR): 46.5–60.0) than nonconvulsive seizures (median: 0.26 min, IQR: 0.008–0.9; p < 0.001). For postictal hyperventilation, the return to baseline was longer in convulsive seizures (median: 25.3 min, IQR: 8.1–60) than nonconvulsive seizures (median: 1.0 min, IQR: 0.07–3.2; p < 0.001). The LF power band of postictal HRV was lower in convulsive seizures than nonconvulsive seizures (ROM: 0.33, 95% CI: 0.11–0.96; p = 0.043). Convulsive seizures with postictal generalized EEG suppression (PGES; n = 12) were associated with lower postictal heart and respiratory rate, and increased HRV, compared with those without (n = 6).
Profound cardiorespiratory and autonomic dysfunction associated with convulsive seizures may explain why these seizures carry the greatest risk of SUDEP.
•Convulsive and nonconvulsive seizures alter cardiorespiratory function.•Cardiorespiratory function is substantially altered in convulsive seizures.•Ictal apnea duration was longer in convulsive seizures, and commonly obstructive.•Convulsive seizures have prolonged postictal tachycardia and hyperventilation.</description><identifier>ISSN: 1525-5050</identifier><identifier>EISSN: 1525-5069</identifier><identifier>DOI: 10.1016/j.yebeh.2020.107271</identifier><identifier>PMID: 32653843</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Autonomic Nervous System Diseases - diagnosis ; Autonomic Nervous System Diseases - epidemiology ; Autonomic Nervous System Diseases - physiopathology ; Cardiorespiratory function ; Electroencephalography - methods ; Epilepsy ; Female ; Heart Rate - physiology ; HRV ; Humans ; Hyperventilation - diagnosis ; Hyperventilation - epidemiology ; Hyperventilation - physiopathology ; Male ; Middle Aged ; Polysomnography - methods ; Seizures ; Seizures - diagnosis ; Seizures - epidemiology ; Seizures - physiopathology ; Sudden Unexpected Death in Epilepsy - epidemiology ; SUDEP ; Tachycardia - diagnosis ; Tachycardia - epidemiology ; Tachycardia - physiopathology ; Video Recording - methods ; Young Adult</subject><ispartof>Epilepsy & behavior, 2020-10, Vol.111, p.107271-107271, Article 107271</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-eaf5cf67ea47a9ed528ab7635973a9bd86beb0e93eb29db0935609780d127fd03</citedby><cites>FETCH-LOGICAL-c359t-eaf5cf67ea47a9ed528ab7635973a9bd86beb0e93eb29db0935609780d127fd03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1525505020304509$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32653843$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sivathamboo, Shobi</creatorcontrib><creatorcontrib>Constantino, Thomas N.</creatorcontrib><creatorcontrib>Chen, Zhibin</creatorcontrib><creatorcontrib>Sparks, Paul B.</creatorcontrib><creatorcontrib>Goldin, Jeremy</creatorcontrib><creatorcontrib>Velakoulis, Dennis</creatorcontrib><creatorcontrib>Jones, Nigel C.</creatorcontrib><creatorcontrib>Kwan, Patrick</creatorcontrib><creatorcontrib>Macefield, Vaughan G.</creatorcontrib><creatorcontrib>O'Brien, Terence J.</creatorcontrib><creatorcontrib>Perucca, Piero</creatorcontrib><title>Cardiorespiratory and autonomic function in epileptic seizures: A video-EEG monitoring study</title><title>Epilepsy & behavior</title><addtitle>Epilepsy Behav</addtitle><description>Seizure-induced cardiorespiratory and autonomic dysfunction has long been recognized, and growing evidence points to its implication in sudden unexpected death in epilepsy (SUDEP). However, a comprehensive understanding of cardiorespiratory function in the preictal, ictal, and postictal periods are lacking.
We examined continuous cardiorespiratory and autonomic function in 157 seizures (18 convulsive and 139 nonconvulsive) from 70 consecutive patients who had a seizure captured on concurrent video-encephalogram (EEG) monitoring and polysomnography between February 1, 2012 and May 31, 2017. Heart and respiratory rates, heart rate variability (HRV), and oxygen saturation were assessed across four distinct periods: baseline (120 s), preictal (60 s), ictal, and postictal (300 s). Heart and respiratory rates were further followed for up to 60 min after seizure termination to assess return to baseline.
Ictal tachycardia occurred during both convulsive and nonconvulsive seizures, but the maximum rate was higher for convulsive seizures (mean: 138.8 beats/min, 95% confidence interval (CI): 125.3–152.4) compared with nonconvulsive seizures (mean: 105.4 beats/min, 95% CI: 101.2–109.6; p < 0.001). Convulsive seizures were associated with a lower ictal minimum respiratory rate (mean: 0 breaths/min, 95% CI: 0–0) compared with nonconvulsive seizures (mean: 11.0 breaths/min, 95% CI: 9.5–12.6; p < 0.001). Ictal obstructive apnea was associated with convulsive compared with nonconvulsive seizures. The low-frequency (LF) power band of ictal HRV was higher among convulsive seizures than nonconvulsive seizures (ratio of means (ROM): 2.97, 95% CI: 1.34–6.60; p = 0.008). Postictal tachycardia was substantially prolonged, characterized by a longer return to baseline for convulsive seizures (median: 60.0 min, interquartile range (IQR): 46.5–60.0) than nonconvulsive seizures (median: 0.26 min, IQR: 0.008–0.9; p < 0.001). For postictal hyperventilation, the return to baseline was longer in convulsive seizures (median: 25.3 min, IQR: 8.1–60) than nonconvulsive seizures (median: 1.0 min, IQR: 0.07–3.2; p < 0.001). The LF power band of postictal HRV was lower in convulsive seizures than nonconvulsive seizures (ROM: 0.33, 95% CI: 0.11–0.96; p = 0.043). Convulsive seizures with postictal generalized EEG suppression (PGES; n = 12) were associated with lower postictal heart and respiratory rate, and increased HRV, compared with those without (n = 6).
Profound cardiorespiratory and autonomic dysfunction associated with convulsive seizures may explain why these seizures carry the greatest risk of SUDEP.
•Convulsive and nonconvulsive seizures alter cardiorespiratory function.•Cardiorespiratory function is substantially altered in convulsive seizures.•Ictal apnea duration was longer in convulsive seizures, and commonly obstructive.•Convulsive seizures have prolonged postictal tachycardia and hyperventilation.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Autonomic Nervous System Diseases - diagnosis</subject><subject>Autonomic Nervous System Diseases - epidemiology</subject><subject>Autonomic Nervous System Diseases - physiopathology</subject><subject>Cardiorespiratory function</subject><subject>Electroencephalography - methods</subject><subject>Epilepsy</subject><subject>Female</subject><subject>Heart Rate - physiology</subject><subject>HRV</subject><subject>Humans</subject><subject>Hyperventilation - diagnosis</subject><subject>Hyperventilation - epidemiology</subject><subject>Hyperventilation - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Polysomnography - methods</subject><subject>Seizures</subject><subject>Seizures - diagnosis</subject><subject>Seizures - epidemiology</subject><subject>Seizures - physiopathology</subject><subject>Sudden Unexpected Death in Epilepsy - epidemiology</subject><subject>SUDEP</subject><subject>Tachycardia - diagnosis</subject><subject>Tachycardia - epidemiology</subject><subject>Tachycardia - physiopathology</subject><subject>Video Recording - methods</subject><subject>Young Adult</subject><issn>1525-5050</issn><issn>1525-5069</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9LAzEQxYMoWqufQJAcvWzNn2bTFTyUUqtQ8KI3IWSTWU3pJmuyW6if3q2tHj3NMPPePOaH0BUlI0pofrsabaGEjxEjbDeRTNIjNKCCiUyQvDj-6wU5Q-cprQihVHB6is44ywWfjPkAvc10tC5ESI2Lug1xi7W3WHdt8KF2BledN60LHjuPoXFraNp-msB9db3pDk_xxlkI2Xy-wHXwrj_h_DtObWe3F-ik0usEl4c6RK8P85fZY7Z8XjzNpsvMcFG0GehKmCqXoMdSF2AFm-hS5v1Ocl2UdpKXUBIoOJSssCUpuMhJISfEUiYrS_gQ3ezvNjF8dpBaVbtkYL3WHkKXFBszLqgUbNxL-V5qYkgpQqWa6Godt4oStcOqVuoHq9phVXusvev6ENCVNdg_zy_HXnC_F0D_5sZBVMk48Aasi2BaZYP7N-Ab1LmK2g</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Sivathamboo, Shobi</creator><creator>Constantino, Thomas N.</creator><creator>Chen, Zhibin</creator><creator>Sparks, Paul B.</creator><creator>Goldin, Jeremy</creator><creator>Velakoulis, Dennis</creator><creator>Jones, Nigel C.</creator><creator>Kwan, Patrick</creator><creator>Macefield, Vaughan G.</creator><creator>O'Brien, Terence J.</creator><creator>Perucca, Piero</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202010</creationdate><title>Cardiorespiratory and autonomic function in epileptic seizures: A video-EEG monitoring study</title><author>Sivathamboo, Shobi ; Constantino, Thomas N. ; Chen, Zhibin ; Sparks, Paul B. ; Goldin, Jeremy ; Velakoulis, Dennis ; Jones, Nigel C. ; Kwan, Patrick ; Macefield, Vaughan G. ; O'Brien, Terence J. ; Perucca, Piero</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-eaf5cf67ea47a9ed528ab7635973a9bd86beb0e93eb29db0935609780d127fd03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Autonomic Nervous System Diseases - diagnosis</topic><topic>Autonomic Nervous System Diseases - epidemiology</topic><topic>Autonomic Nervous System Diseases - physiopathology</topic><topic>Cardiorespiratory function</topic><topic>Electroencephalography - methods</topic><topic>Epilepsy</topic><topic>Female</topic><topic>Heart Rate - physiology</topic><topic>HRV</topic><topic>Humans</topic><topic>Hyperventilation - diagnosis</topic><topic>Hyperventilation - epidemiology</topic><topic>Hyperventilation - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Polysomnography - methods</topic><topic>Seizures</topic><topic>Seizures - diagnosis</topic><topic>Seizures - epidemiology</topic><topic>Seizures - physiopathology</topic><topic>Sudden Unexpected Death in Epilepsy - epidemiology</topic><topic>SUDEP</topic><topic>Tachycardia - diagnosis</topic><topic>Tachycardia - epidemiology</topic><topic>Tachycardia - physiopathology</topic><topic>Video Recording - methods</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sivathamboo, Shobi</creatorcontrib><creatorcontrib>Constantino, Thomas N.</creatorcontrib><creatorcontrib>Chen, Zhibin</creatorcontrib><creatorcontrib>Sparks, Paul B.</creatorcontrib><creatorcontrib>Goldin, Jeremy</creatorcontrib><creatorcontrib>Velakoulis, Dennis</creatorcontrib><creatorcontrib>Jones, Nigel C.</creatorcontrib><creatorcontrib>Kwan, Patrick</creatorcontrib><creatorcontrib>Macefield, Vaughan G.</creatorcontrib><creatorcontrib>O'Brien, Terence J.</creatorcontrib><creatorcontrib>Perucca, Piero</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Epilepsy & behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sivathamboo, Shobi</au><au>Constantino, Thomas N.</au><au>Chen, Zhibin</au><au>Sparks, Paul B.</au><au>Goldin, Jeremy</au><au>Velakoulis, Dennis</au><au>Jones, Nigel C.</au><au>Kwan, Patrick</au><au>Macefield, Vaughan G.</au><au>O'Brien, Terence J.</au><au>Perucca, Piero</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiorespiratory and autonomic function in epileptic seizures: A video-EEG monitoring study</atitle><jtitle>Epilepsy & behavior</jtitle><addtitle>Epilepsy Behav</addtitle><date>2020-10</date><risdate>2020</risdate><volume>111</volume><spage>107271</spage><epage>107271</epage><pages>107271-107271</pages><artnum>107271</artnum><issn>1525-5050</issn><eissn>1525-5069</eissn><abstract>Seizure-induced cardiorespiratory and autonomic dysfunction has long been recognized, and growing evidence points to its implication in sudden unexpected death in epilepsy (SUDEP). However, a comprehensive understanding of cardiorespiratory function in the preictal, ictal, and postictal periods are lacking.
We examined continuous cardiorespiratory and autonomic function in 157 seizures (18 convulsive and 139 nonconvulsive) from 70 consecutive patients who had a seizure captured on concurrent video-encephalogram (EEG) monitoring and polysomnography between February 1, 2012 and May 31, 2017. Heart and respiratory rates, heart rate variability (HRV), and oxygen saturation were assessed across four distinct periods: baseline (120 s), preictal (60 s), ictal, and postictal (300 s). Heart and respiratory rates were further followed for up to 60 min after seizure termination to assess return to baseline.
Ictal tachycardia occurred during both convulsive and nonconvulsive seizures, but the maximum rate was higher for convulsive seizures (mean: 138.8 beats/min, 95% confidence interval (CI): 125.3–152.4) compared with nonconvulsive seizures (mean: 105.4 beats/min, 95% CI: 101.2–109.6; p < 0.001). Convulsive seizures were associated with a lower ictal minimum respiratory rate (mean: 0 breaths/min, 95% CI: 0–0) compared with nonconvulsive seizures (mean: 11.0 breaths/min, 95% CI: 9.5–12.6; p < 0.001). Ictal obstructive apnea was associated with convulsive compared with nonconvulsive seizures. The low-frequency (LF) power band of ictal HRV was higher among convulsive seizures than nonconvulsive seizures (ratio of means (ROM): 2.97, 95% CI: 1.34–6.60; p = 0.008). Postictal tachycardia was substantially prolonged, characterized by a longer return to baseline for convulsive seizures (median: 60.0 min, interquartile range (IQR): 46.5–60.0) than nonconvulsive seizures (median: 0.26 min, IQR: 0.008–0.9; p < 0.001). For postictal hyperventilation, the return to baseline was longer in convulsive seizures (median: 25.3 min, IQR: 8.1–60) than nonconvulsive seizures (median: 1.0 min, IQR: 0.07–3.2; p < 0.001). The LF power band of postictal HRV was lower in convulsive seizures than nonconvulsive seizures (ROM: 0.33, 95% CI: 0.11–0.96; p = 0.043). Convulsive seizures with postictal generalized EEG suppression (PGES; n = 12) were associated with lower postictal heart and respiratory rate, and increased HRV, compared with those without (n = 6).
Profound cardiorespiratory and autonomic dysfunction associated with convulsive seizures may explain why these seizures carry the greatest risk of SUDEP.
•Convulsive and nonconvulsive seizures alter cardiorespiratory function.•Cardiorespiratory function is substantially altered in convulsive seizures.•Ictal apnea duration was longer in convulsive seizures, and commonly obstructive.•Convulsive seizures have prolonged postictal tachycardia and hyperventilation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32653843</pmid><doi>10.1016/j.yebeh.2020.107271</doi><tpages>1</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Autonomic Nervous System Diseases - diagnosis Autonomic Nervous System Diseases - epidemiology Autonomic Nervous System Diseases - physiopathology Cardiorespiratory function Electroencephalography - methods Epilepsy Female Heart Rate - physiology HRV Humans Hyperventilation - diagnosis Hyperventilation - epidemiology Hyperventilation - physiopathology Male Middle Aged Polysomnography - methods Seizures Seizures - diagnosis Seizures - epidemiology Seizures - physiopathology Sudden Unexpected Death in Epilepsy - epidemiology SUDEP Tachycardia - diagnosis Tachycardia - epidemiology Tachycardia - physiopathology Video Recording - methods Young Adult |
| title | Cardiorespiratory and autonomic function in epileptic seizures: A video-EEG monitoring study |
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