Dr. Hampel is neurologist with special interest in autonomic function and epilepsy surgery. SUMMARYObjective: Cardiorespiratory function alterations are commonly observed with epileptic seizures and may lead to syncope and sudden unexpected death in epilepsy (SUDEP). Although most previous research has focused on controlling heart rate (HR) and respiration, little is known about seizure-related regulation of systemic blood pressure (BP). Herein, we have investigated whether the periictal modulation of systemic BP and HR depends on seizure characteristics. Methods: Systemic arterial BP, HR, and peripheral capillary oxygen saturation (SPO 2 ) were continuously and noninvasively monitored using the ccNexfin device in those epilepsy patients undergoing video-electroencephalography (EEG) telemetry. Data are given as mean AE standard deviation (SD). Results: Forty-five seizures in 37 patients were included. In focal seizures (FS, n = 35), the mean arterial BP (MAP) increased by 33 AE 35% and the HR by 53 AE 44%, whereas the SPO 2 remained unaltered. The MAP and HR increases were significantly greater in FS with alterations in consciousness than in those without. For those FS that evolved to bilateral convulsive seizures (BCS, n = 10), all of the ictal recordings were compromised by artifacts. However, 2 min after seizure cessation, the MAP was enhanced by only 16 AE 14% and returned to a baseline slightly below preictal levels after 5 min, whereas the HR was increased by 77 AE 33% and remained elevated throughout the postictal phase. Significance: Periictal regulation of systemic BP and HR displays distinct patterns depending on the type of seizure with focal onset. These changes were unrelated to alterations in SPO 2 . The potential clinical implications of these findings are discussed in the article. KEY WORDS: Systemic blood pressure, Syncope, Sudden unexpected death in epilepsy.Epileptic seizures affect the autonomic nervous system in many ways including modulation of the gastrointestinal (e.g., spitting, vomiting), cardiac (tachycardia, bradycardia), and respiratory (tachypnea, hypopnea and apnea) functions.1,2 Depending on their severity, cardiorespiratory alterations can lead to syncope or sudden unexpected death in epilepsy (SUDEP).3-5 In most of the previous studies addressing seizure-related cardiorespiratory function, the cardiac rhythm and oxygen saturation were assessed either separately or together. [6][7][8][9] The supply of oxygen and metabolites, however, critically depends on the blood perfusion of the different organs which is, in turn, tightly regulated in most organs and connected to systemic blood pressure (BP). In this context, a recent study has shown that during the interictal period, the diastolic BP for those individuals who subsequently died as a result of SUDEP, tended to be higher than for the epilepsy controls.10 This could be due to an epilepsy-related increase in the activity of the sympathetic branch of the autonomic nervous system. 11 To date, however, little is known about seizure-r...

Objective:To determine the recurrence risk of ictal asystole (IA) and its determining factors in people with epilepsy.Methods:We performed a systematic review of published cases with IA in 3 databases and additionally searched our local database for patients with multiple seizures simultaneously recorded with ECG and EEG and at least one IA. IA recurrence risk was estimated by including all seizures without knowledge of the chronological order. Various clinical features were assessed by an individual patient data meta-analysis. A random mixed effect logistic regression model was applied to estimate the average recurrence risk of IA. Plausibility of the calculated IA recurrence risk was checked by analyzing the local dataset with available information in chronological order.Results:Eighty patients with 182 IA in 537 seizures were included. Recurrence risk of IA amounted to 40% (95% confidence interval [CI] 32%–50%). None of the clinical factors (age, sex, type and duration of epilepsy, hemispheric lateralization, duration of IA per patient) appeared to have a significant effect on the short-term recurrence risk of IA. When considering the local dataset only, IA recurrence risk was estimated to 30% (95% CI 14%–53%). Information whether IA coincided with symptoms (i.e., syncope) or not was given in 60 patients: 100 out of 142 IAs were symptomatic.Conclusion:Our data suggest that in case of clinically suspected IA, the recording of 1 or 2 seizures is not sufficient to rule out IA. Furthermore, the high short-term recurrence risk favors aggressive treatment, including pacemaker implantation if seizure freedom cannot be achieved.