The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea
Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if...
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| Veröffentlicht in: | Epilepsy & behavior 2019-09, Vol.98 (Pt A), p.73-79 |
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| creator | Lacuey, Nuria Martins, Rita Vilella, Laura Hampson, Johnson P. Rani, M.R. Sandhya Strohl, Kingman Zaremba, Anita Hampson, Jaison S. Sainju, Rup K. Friedman, Daniel Nei, Maromi Scott, Catherine Gehlbach, Brian K. Hupp, Norma J. Schuele, Stephan Ogren, Jennifer Harper, Ronald M. Allen, Luke Diehl, Beate Bateman, Lisa M. Devinsky, Orrin Richerson, George B. Lhatoo, Samden |
| description | Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy.
Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group.
Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05).
Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
•Seizures in patients taking serotonin reuptake inhibitors (SRIs) have lower relative risk for Ictal Central Apnea (ICA)•Seizures in patients taking benzodiazepines (BZDs) are associated with shorter ICA duration, but not with ICA incidence.•Seizures in patients taking BZDs have shorter generalized convulsive seizures, as well as PGES durations.•Seizures in patients on SRIs or BZDs have less severe hypoxemia than in the control group (no SRIs or BZDs). |
| doi_str_mv | 10.1016/j.yebeh.2019.06.029 |
| format | Article |
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Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group.
Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05).
Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
•Seizures in patients taking serotonin reuptake inhibitors (SRIs) have lower relative risk for Ictal Central Apnea (ICA)•Seizures in patients taking benzodiazepines (BZDs) are associated with shorter ICA duration, but not with ICA incidence.•Seizures in patients taking BZDs have shorter generalized convulsive seizures, as well as PGES durations.•Seizures in patients on SRIs or BZDs have less severe hypoxemia than in the control group (no SRIs or BZDs).</description><identifier>ISSN: 1525-5050</identifier><identifier>EISSN: 1525-5069</identifier><identifier>DOI: 10.1016/j.yebeh.2019.06.029</identifier><identifier>PMID: 31301453</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Benzodiazepines ; Benzodiazepines - therapeutic use ; Cohort Studies ; Electroencephalography - methods ; Epilepsy - drug therapy ; Epilepsy - physiopathology ; Female ; Humans ; Hypoxia - drug therapy ; Hypoxia - physiopathology ; Ictal central apnea ; Male ; Middle Aged ; Oximetry - methods ; Prospective Studies ; Seizures ; Seizures - drug therapy ; Seizures - physiopathology ; Serotonin reuptake inhibitors ; Serotonin Uptake Inhibitors - therapeutic use ; Sleep Apnea, Central - drug therapy ; Sleep Apnea, Central - physiopathology ; Sudden Unexpected Death in Epilepsy - prevention & control ; SUDEP ; Young Adult</subject><ispartof>Epilepsy & behavior, 2019-09, Vol.98 (Pt A), p.73-79</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c487t-2389401ba905f99be349c4e885a6e37bbf5af70da595bf4b6ae0a56f34e4d9be3</citedby><cites>FETCH-LOGICAL-c487t-2389401ba905f99be349c4e885a6e37bbf5af70da595bf4b6ae0a56f34e4d9be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S152550501930335X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31301453$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lacuey, Nuria</creatorcontrib><creatorcontrib>Martins, Rita</creatorcontrib><creatorcontrib>Vilella, Laura</creatorcontrib><creatorcontrib>Hampson, Johnson P.</creatorcontrib><creatorcontrib>Rani, M.R. Sandhya</creatorcontrib><creatorcontrib>Strohl, Kingman</creatorcontrib><creatorcontrib>Zaremba, Anita</creatorcontrib><creatorcontrib>Hampson, Jaison S.</creatorcontrib><creatorcontrib>Sainju, Rup K.</creatorcontrib><creatorcontrib>Friedman, Daniel</creatorcontrib><creatorcontrib>Nei, Maromi</creatorcontrib><creatorcontrib>Scott, Catherine</creatorcontrib><creatorcontrib>Gehlbach, Brian K.</creatorcontrib><creatorcontrib>Hupp, Norma J.</creatorcontrib><creatorcontrib>Schuele, Stephan</creatorcontrib><creatorcontrib>Ogren, Jennifer</creatorcontrib><creatorcontrib>Harper, Ronald M.</creatorcontrib><creatorcontrib>Allen, Luke</creatorcontrib><creatorcontrib>Diehl, Beate</creatorcontrib><creatorcontrib>Bateman, Lisa M.</creatorcontrib><creatorcontrib>Devinsky, Orrin</creatorcontrib><creatorcontrib>Richerson, George B.</creatorcontrib><creatorcontrib>Lhatoo, Samden</creatorcontrib><title>The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea</title><title>Epilepsy & behavior</title><addtitle>Epilepsy Behav</addtitle><description>Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy.
Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group.
Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05).
Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
•Seizures in patients taking serotonin reuptake inhibitors (SRIs) have lower relative risk for Ictal Central Apnea (ICA)•Seizures in patients taking benzodiazepines (BZDs) are associated with shorter ICA duration, but not with ICA incidence.•Seizures in patients taking BZDs have shorter generalized convulsive seizures, as well as PGES durations.•Seizures in patients on SRIs or BZDs have less severe hypoxemia than in the control group (no SRIs or BZDs).</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Benzodiazepines</subject><subject>Benzodiazepines - therapeutic use</subject><subject>Cohort Studies</subject><subject>Electroencephalography - methods</subject><subject>Epilepsy - drug therapy</subject><subject>Epilepsy - physiopathology</subject><subject>Female</subject><subject>Humans</subject><subject>Hypoxia - drug therapy</subject><subject>Hypoxia - physiopathology</subject><subject>Ictal central apnea</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Oximetry - methods</subject><subject>Prospective Studies</subject><subject>Seizures</subject><subject>Seizures - drug therapy</subject><subject>Seizures - physiopathology</subject><subject>Serotonin reuptake inhibitors</subject><subject>Serotonin Uptake Inhibitors - therapeutic use</subject><subject>Sleep Apnea, Central - drug therapy</subject><subject>Sleep Apnea, Central - physiopathology</subject><subject>Sudden Unexpected Death in Epilepsy - prevention & control</subject><subject>SUDEP</subject><subject>Young Adult</subject><issn>1525-5050</issn><issn>1525-5069</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhiMEoqXwC5CQj1w2tWM7iQ8goYqPSpW4lCOyxs6EzLJrB9tb1P56suyyggunseRn3hnNU1UvBa8FF-3lur5Hh1PdcGFq3ta8MY-qc6EbvdK8NY9Pb83Pqmc5rzkXQkvxtDqTQnKhtDyvvt5OyCDn6AkKxcDiyDKmWGKgwBLu5gLfkVGYyFGJKTMIA3MYHuJA8IAzBczsJ5WJkS-wYR5DSUuFOSA8r56MsMn44lgvqi8f3t9efVrdfP54ffXuZuVV35VVI3ujuHBguB6NcSiV8Qr7XkOLsnNu1DB2fABttBuVawE56HaUCtWwxy-qt4fceee2OBx3sHOiLaR7G4Hsvz-BJvst3tnedFq0Zgl4fQxI8ccOc7Fbyh43GwgYd9k2je460UitFlQeUJ9izgnH0xjB7V6MXdvfYuxejOWtXcQsXa_-3vDU88fEArw5ALjc6Y4w2ewJg8eBEvpih0j_HfALtGujhQ</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Lacuey, Nuria</creator><creator>Martins, Rita</creator><creator>Vilella, Laura</creator><creator>Hampson, Johnson P.</creator><creator>Rani, M.R. Sandhya</creator><creator>Strohl, Kingman</creator><creator>Zaremba, Anita</creator><creator>Hampson, Jaison S.</creator><creator>Sainju, Rup K.</creator><creator>Friedman, Daniel</creator><creator>Nei, Maromi</creator><creator>Scott, Catherine</creator><creator>Gehlbach, Brian K.</creator><creator>Hupp, Norma J.</creator><creator>Schuele, Stephan</creator><creator>Ogren, Jennifer</creator><creator>Harper, Ronald M.</creator><creator>Allen, Luke</creator><creator>Diehl, Beate</creator><creator>Bateman, Lisa M.</creator><creator>Devinsky, Orrin</creator><creator>Richerson, George B.</creator><creator>Lhatoo, Samden</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><scope>5PM</scope></search><sort><creationdate>20190901</creationdate><title>The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea</title><author>Lacuey, Nuria ; Martins, Rita ; Vilella, Laura ; Hampson, Johnson P. ; Rani, M.R. Sandhya ; Strohl, Kingman ; Zaremba, Anita ; Hampson, Jaison S. ; Sainju, Rup K. ; Friedman, Daniel ; Nei, Maromi ; Scott, Catherine ; Gehlbach, Brian K. ; Hupp, Norma J. ; Schuele, Stephan ; Ogren, Jennifer ; Harper, Ronald M. ; Allen, Luke ; Diehl, Beate ; Bateman, Lisa M. ; Devinsky, Orrin ; Richerson, George B. ; Lhatoo, Samden</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c487t-2389401ba905f99be349c4e885a6e37bbf5af70da595bf4b6ae0a56f34e4d9be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Benzodiazepines</topic><topic>Benzodiazepines - therapeutic use</topic><topic>Cohort Studies</topic><topic>Electroencephalography - methods</topic><topic>Epilepsy - drug therapy</topic><topic>Epilepsy - physiopathology</topic><topic>Female</topic><topic>Humans</topic><topic>Hypoxia - drug therapy</topic><topic>Hypoxia - physiopathology</topic><topic>Ictal central apnea</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Oximetry - methods</topic><topic>Prospective Studies</topic><topic>Seizures</topic><topic>Seizures - drug therapy</topic><topic>Seizures - physiopathology</topic><topic>Serotonin reuptake inhibitors</topic><topic>Serotonin Uptake Inhibitors - therapeutic use</topic><topic>Sleep Apnea, Central - drug therapy</topic><topic>Sleep Apnea, Central - physiopathology</topic><topic>Sudden Unexpected Death in Epilepsy - prevention & control</topic><topic>SUDEP</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lacuey, Nuria</creatorcontrib><creatorcontrib>Martins, Rita</creatorcontrib><creatorcontrib>Vilella, Laura</creatorcontrib><creatorcontrib>Hampson, Johnson P.</creatorcontrib><creatorcontrib>Rani, M.R. Sandhya</creatorcontrib><creatorcontrib>Strohl, Kingman</creatorcontrib><creatorcontrib>Zaremba, Anita</creatorcontrib><creatorcontrib>Hampson, Jaison S.</creatorcontrib><creatorcontrib>Sainju, Rup K.</creatorcontrib><creatorcontrib>Friedman, Daniel</creatorcontrib><creatorcontrib>Nei, Maromi</creatorcontrib><creatorcontrib>Scott, Catherine</creatorcontrib><creatorcontrib>Gehlbach, Brian K.</creatorcontrib><creatorcontrib>Hupp, Norma J.</creatorcontrib><creatorcontrib>Schuele, Stephan</creatorcontrib><creatorcontrib>Ogren, Jennifer</creatorcontrib><creatorcontrib>Harper, Ronald M.</creatorcontrib><creatorcontrib>Allen, Luke</creatorcontrib><creatorcontrib>Diehl, Beate</creatorcontrib><creatorcontrib>Bateman, Lisa M.</creatorcontrib><creatorcontrib>Devinsky, Orrin</creatorcontrib><creatorcontrib>Richerson, George B.</creatorcontrib><creatorcontrib>Lhatoo, Samden</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><collection>PubMed Central (Full Participant titles)</collection><jtitle>Epilepsy & behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lacuey, Nuria</au><au>Martins, Rita</au><au>Vilella, Laura</au><au>Hampson, Johnson P.</au><au>Rani, M.R. Sandhya</au><au>Strohl, Kingman</au><au>Zaremba, Anita</au><au>Hampson, Jaison S.</au><au>Sainju, Rup K.</au><au>Friedman, Daniel</au><au>Nei, Maromi</au><au>Scott, Catherine</au><au>Gehlbach, Brian K.</au><au>Hupp, Norma J.</au><au>Schuele, Stephan</au><au>Ogren, Jennifer</au><au>Harper, Ronald M.</au><au>Allen, Luke</au><au>Diehl, Beate</au><au>Bateman, Lisa M.</au><au>Devinsky, Orrin</au><au>Richerson, George B.</au><au>Lhatoo, Samden</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea</atitle><jtitle>Epilepsy & behavior</jtitle><addtitle>Epilepsy Behav</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>98</volume><issue>Pt A</issue><spage>73</spage><epage>79</epage><pages>73-79</pages><issn>1525-5050</issn><eissn>1525-5069</eissn><abstract>Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy.
Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group.
Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05).
Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
•Seizures in patients taking serotonin reuptake inhibitors (SRIs) have lower relative risk for Ictal Central Apnea (ICA)•Seizures in patients taking benzodiazepines (BZDs) are associated with shorter ICA duration, but not with ICA incidence.•Seizures in patients taking BZDs have shorter generalized convulsive seizures, as well as PGES durations.•Seizures in patients on SRIs or BZDs have less severe hypoxemia than in the control group (no SRIs or BZDs).</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31301453</pmid><doi>10.1016/j.yebeh.2019.06.029</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Benzodiazepines Benzodiazepines - therapeutic use Cohort Studies Electroencephalography - methods Epilepsy - drug therapy Epilepsy - physiopathology Female Humans Hypoxia - drug therapy Hypoxia - physiopathology Ictal central apnea Male Middle Aged Oximetry - methods Prospective Studies Seizures Seizures - drug therapy Seizures - physiopathology Serotonin reuptake inhibitors Serotonin Uptake Inhibitors - therapeutic use Sleep Apnea, Central - drug therapy Sleep Apnea, Central - physiopathology Sudden Unexpected Death in Epilepsy - prevention & control SUDEP Young Adult |
| title | The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea |
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