Ictal central apnea as a predictor for sudden unexpected death in epilepsy

Schuele, Stephan; Afshari, Mitra; Afshari, Zahra S.; Macken, Michael; Asconapé, Jorge J.; Wolfe, Lisa F.; Gerard, Elizabeth E.

doi:10.1016/j.yebeh.2011.06.036

Cited by 33 publications

(30 citation statements)

References 9 publications

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“…Asphyxia in animal models results in heart rate decline and cardiac arrest in approximately 5 minutes 23 . Consistent with the literature, 12, 24 even in the rare, prolonged ICA epochs (up to 97 seconds), no bradycardia was observed in our study. Seizure-driven tachycardia is common 25 , and may conceivably have overcome any physiological tendency to bradycardia in these patients.…”

Section: Discussionsupporting

confidence: 93%

“…Indeed, two non-fatal ICA durations of 57 and 58 seconds, with SpO 2 of 68% and 62%, respectively were recorded in a previously reported patient who subsequently died of SUDEP at home. 12 Longer duration of epilepsy is a known SUDEP risk factor 26 . Our observation of a positive correlation between duration of epilepsy and ICA duration is intriguing, and suggests potential plasticity in respiratory circuitry that may render relatively benign, short duration ICA into potentially lethal, longer duration ICA that may predispose to SUDEP.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Ictal apnea has also been noted in 44-48% of nongeneralizing focal seizures, 2,4,7,8 and has been reported as the main manifestation of focal seizures in a few case reports. 9,10 Ictal and postictal central apnea has been suggested as a potential mechanism in some SUDEP 11 and near-SUDEP 12 cases. However, the role of ictal and postictal central apnea in SUDEP remains to be definitively demonstrated.…”

Section: Introductionmentioning

confidence: 99%

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The incidence and significance of periictal apnea in epileptic seizures

Zonjy²,

et al. 2018

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ICA is a frequent, self-limiting semiological feature of focal epilepsy, often starting before surface EEG onset, and may be the only clinical manifestation of focal seizures. However, prolonged ICA (≥60 s) is associated with severe hypoxemia and may be a potential SUDEP biomarker. ICA is more frequently seen in temporal than extratemporal seizures, and in typical temporal seizure semiologies. ICA rarely persists after seizure end. ICA agnosia is typical, and thus it may remain unrecognized without polygraphic measurements that include breathing parameters.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The incidence and significance of periictal apnea in epileptic seizures

Zonjy²,

et al. 2018

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“…Our case differs from the others reported in the literature as ictal CSA, because the EEG abnormalities and seizures, instead of appearing before or together with the breathing episodes, began always after the end of the respiratory event [5]. Each epileptic event is also associated with an autonomic response, which in theory might enhance the risk of sudden death in epilepsy (SUDEP) [6].…”

Section: Discussioncontrasting

confidence: 51%

Sleep-onset central apneas as triggers of severe nocturnal seizures

Khachatryan¹,

Prosperetti²,

Rossinelli³

et al. 2015

Sleep Medicine

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“…Medullary-forebrain connectivity through the human LFB also provides a potential neuroanatomic basis for CHN disorders such as SUDEP (Engel et al, 2013;Richardson, 2012;Sowers et al, 2013), which is associated with temporal lobe epilepsy (Mueller et al, 2014;Schuele et al, 2011), as well as SIDS and SUDC, which are associated with hippocampal anomalies in infants and young children, respectively (Kinney et al, 2007(Kinney et al, , 2009(Kinney et al, , 2015. A paradoxical feature of the CHN is its marked susceptibility to generate and propagate seizures (Harper, 1986;Oliveira et al, 2011)-paradoxical in that a network so vital to survival is so prone to seizures that are inherently dangerous and potentially lethal.…”

Section: Human Central Homeostatic Network 195 Discussionmentioning

confidence: 99%

The Structural Connectome of the Human Central Homeostatic Network

et al. 2016

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Homeostatic adaptations to stress are regulated by interactions between the brainstem and regions of the forebrain, including limbic sites related to respiratory, autonomic, affective, and cognitive processing. Neuroanatomic connections between these homeostatic regions, however, have not been thoroughly identified in the human brain. In this study, we perform diffusion spectrum imaging tractography using the MGH-USC Connectome MRI scanner to visualize structural connections in the human brain linking autonomic and cardiorespiratory nuclei in the midbrain, pons, and medulla oblongata with forebrain sites critical to homeostatic control. Probabilistic tractography analyses in six healthy adults revealed connections between six brainstem nuclei and seven forebrain regions, several over long distances between the caudal medulla and cerebral cortex. The strongest evidence for brainstem-homeostatic forebrain connectivity in this study was between the brainstem midline raphe and the medial temporal lobe. The subiculum and amygdala were the sampled forebrain nodes with the most extensive brainstem connections. Within the human brainstem-homeostatic forebrain connectome, we observed that a lateral forebrain bundle, whose connectivity is distinct from that of rodents and nonhuman primates, is the primary conduit for connections between the brainstem and medial temporal lobe. This study supports the concept that interconnected brainstem and forebrain nodes form an integrated central homeostatic network (CHN) in the human brain. Our findings provide an initial foundation for elucidating the neuroanatomic basis of homeostasis in the normal human brain, as well as for mapping CHN disconnections in patients with disorders of homeostasis, including sudden and unexpected death, and epilepsy.

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Ictal central apnea as a predictor for sudden unexpected death in epilepsy

Cited by 33 publications

References 9 publications

The incidence and significance of periictal apnea in epileptic seizures

The incidence and significance of periictal apnea in epileptic seizures

Sleep-onset central apneas as triggers of severe nocturnal seizures

The Structural Connectome of the Human Central Homeostatic Network

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