Interictal respiratory variability predicts severity of hypoxemia after generalized convulsive seizures

Sainju, Rup K.; Dragon, Deidre Nitschke; Winnike, Harold B; Vilella, Laura; Li, Xiaojin; Lhatoo, Samden D.; Eyck, Patrick Ten; Wendt, Linder H; Richerson, George B.; Gehlbach, Brian K.

doi:10.1111/epi.17691

Cited by 2 publications

(1 citation statement)

References 48 publications

(107 reference statements)

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“…The primary focus is on stabilizing cardiopulmonary function, promptly correcting hyponatremia, and administering anticonvulsant therapy, while actively searching for the underlying cause ( Yozawitz, 2023 ). In the state of hyponatremic seizures, breathing may be easily suppressed, leading to a drop in blood oxygen saturation and potentially resulting in sudden death of the patient ( Sainju et al, 2023 ). From a mechanistic standpoint, acute severe hyponatremia decreases cerebral blood flow and arterial oxygen content, which, when compounded by systemic hypoxemia, severely impairs the brain’s capacity to adapt to the low sodium levels.…”

Section: Discussionmentioning

confidence: 99%

Case report: Acute severe hyponatremia-induced seizures in a newborn: a community-acquired case and literature review

Li,

Chen,

Chen

et al. 2024

Front. Pharmacol.

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Severe neonatal hyponatremia represents a critical electrolyte imbalance with potentially severe neurological outcomes, a condition rarely documented in community-acquired, full-term newborns. This report underscores a unique case of a 23-day-old, previously healthy, full-term male neonate experiencing severe hyponatremia that precipitated seizures, underscoring the urgency of prompt recognition and intervention. The neonate presented with symptoms including vomiting, groaning, chills, fixed staring, and limb tremors. Critical findings upon admission encompassed hypothermia, hypotension, tachycardia, and tachypnea accompanied by significant weight loss. The clinical presentation was marked by dehydration, lethargy, weak crying, a fixed gaze, irregular breathing, and coarse lung sounds, yet a distended abdomen, hypertonic limb movements, and recurrent seizures were observed. Immediate interventions included establishing IV access, rewarming, mechanical ventilation, seizure management, volume expansion, dopamine for circulatory support, and initiation of empirical antibiotics. Diagnostic evaluations revealed a sodium ion concentration of 105.9 mmol/L, while amplitude-integrated electroencephalography (aEEG) detected pronounced seizure activity characterized by a lack of sleep-wake rhythmicity, noticeable elevation in both the lower and upper amplitude margins, and a sustained decrease in the lower margin voltage dropping below 5 μV, presenting as sharp or serrated waveforms. The management strategy entailed rapid electrolyte normalization using hypertonic saline and sodium bicarbonate, anticonvulsant therapy, and comprehensive supportive care, with continuous aEEG monitoring until the cessation of seizures. Remarkably, by the third day, the neonate’s condition had stabilized, allowing for discharge in good health 10 days post-admission. At a 16-month follow-up, the child exhibited no adverse neurological outcomes and demonstrated favorable growth and development. Our extensive review on the etiology, clinical manifestations, aEEG monitoring, characteristics of seizures induced by severe neonatal hyponatremia, treatment approaches, and the prognosis for seizures triggered by severe hyponatremia aims to deepen the understanding and enhance clinical management of this complex condition. It stresses the importance of early detection, accurate diagnosis, and customized treatment protocols to improve outcomes for affected neonates. Additionally, this review accentuates the indispensable role of aEEG monitoring in managing neonates at elevated risk for seizures. Yet, the safety and efficacy of swiftly administering hypertonic saline for correcting severe hyponatremia-induced seizures necessitate further investigation through medical research.

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Section: Discussionmentioning

confidence: 99%

Case report: Acute severe hyponatremia-induced seizures in a newborn: a community-acquired case and literature review

Li,

Chen,

Chen

et al. 2024

Front. Pharmacol.

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Sudden unexpected death in epilepsy: respiratory vs. cardiac contributions

Lin,

Schwartz,

Pitt

2024

Cardiovascular Research

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Sudden unexpected death in epilepsy (SUDEP) poses a significant risk to life expectancy for individuals with epilepsy. Mechanistic insight, while incomplete, has advanced through clinical observational studies and animal models. Yet we lack preventative therapies, which will depend on understanding SUDEP mechanisms. Recurrent convulsive seizures are the major SUDEP risk factor. Cardiorespiratory dysfunction precedes SUDEP, but whether cardiac arrhythmias are major proximate culprits for SUDEP remains to be determined. Here, we highlight recent data from mouse models and clinical studies that provide increasing support for respiratory depression and decreasing evidence for tachyarrhythmia-induced SUDEP. Further, we review data from genetic and chemoconvulsant mouse models that have enabled a deeper understanding for how seizures initiated in the central nervous system propagate to the autonomic nervous system and drive seizure-induced respiratory depression and subsequent SUDEP, rather than supporting a proximate cardiac arrhythmia cause. Ongoing research will continue to identify predictive SUDEP biomarkers, improve animal models, and translate basic research into precision medicine approaches. Identifying and understanding the brainstem circuits vulnerable in seizure-induced apnoea will enable therapeutic interventions to enhance the quality of life and life expectancy for individuals with epilepsy.

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Interictal respiratory variability predicts severity of hypoxemia after generalized convulsive seizures

Cited by 2 publications

References 48 publications

Case report: Acute severe hyponatremia-induced seizures in a newborn: a community-acquired case and literature review

Case report: Acute severe hyponatremia-induced seizures in a newborn: a community-acquired case and literature review

Sudden unexpected death in epilepsy: respiratory vs. cardiac contributions

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