Advantages of respiratory monitoring during video-EEG evaluation to differentiate epileptic seizures from other events

Abstract

Distinction between epileptic (ES) and seizure-like events of non-epileptic nature(SLNE) is often difficult using descriptions of seizure semiology. Cardiopulmonary dysfunction is frequent in ES but has not been objectively examined in relationship to SLNE. Our purpose was to compare cardiopulmonary dysfunction between ES and SLNE. We prospectively recorded cardio-pulmonary function using pulse-oximetry, EKG and respiratory inductance plethysmography (RIP) in 52 ES and 22 SLNE. Comparison of cardiopulmonary complications between ES and SLNE was done using two-sample t-tests and logistic regression. Ictal bradypnea and pre-ictal bradycardia were more frequent in ES than SLNE (p<0.05). Desaturation was found in 57% of ES and 0% SLNE (p<0.0001). Oxygen saturation nadir was significantly lower in ES vs. SLNE (p<0.0001). Ictal-apnea was present in 31% ES and 9% SLNE (p=0.06). Pre-ictal, ictal and post-ictal tachycardia did not significantly differ between ES and SLNE (p>1.0). Cardio-respiratory dysfunction, specifically bradypnea, apnea, pre-ictal bradycardia, and oxygen desaturation, is more frequently seen in ES than in SLNE. Tachycardia was not discriminant between ES and SLNE.

Ictal hypoxemia: A systematic review and meta-analysis

“…The mean baseline SpO2 was 97.5 ± 0.5% (range 97.0-98.0) in three studies [14,32,34]. The mean time to SpO2 nadir was 47.0 ± 24.3 s (range 31.0-75.0) in three studies [4,5,37], and the mean SpO2 nadir was 82.5 ± 6.5% (range 74.0-88.9) in seven studies [5,8,14,28,34,35,37] and < 60.0% in two studies [13,18].…”

“…Of the 21 studies, seven studies [14,[27][28][29][30][31][32] were considered for the qualitative synthesis only as they reported the occurrence of IH without specifying its frequency. The remaining 14 studies [4][5][6]8,9,13,18,[33][34][35][36][37][38][39] were included in the meta-analysis. Quality assessment revealed a median study quality score of 6/8 (range 1-8) and yielded higher scores (7/8) for those studies included in the meta-analysis.…”

“…Six studies included people with different focal epilepsy types [5,13,30,31,34,38], two with TLE only [37,39] Five studies included focal seizures only [5,31,[37][38][39], 14 included both focal and generalized seizures [4,6,9,13,14,18,[28][29][30][32][33][34][35][36] and two did not report the seizures type [8,25].…”

“…Three studies included drug-resistant patients [8,37,38], two both drug-resistant and non-drug-resistant patients [13,18] and 16 did not specify if patients were drug-resistant or not [4][5][6]9,14,[27][28][29][30][31][32][33][34][35][36]39].…”

“…IRCs include a range of alterations, from central and obstructive apnea, tachypnoea, bradypnea to hypoventilation and hypoxemia [3]. IRCs, and most importantly respiratory depression such as hypoxemia, hypercapnia and central apnea, have attracted attention in several clinical contexts, including SUDEP [4][5][6] and seizure detection in the epilepsy monitoring unit [7][8][9].…”