Neonatal Apneic Seizure of Occipital Lobe Origin: Continuous Video-EEG Recording

Abstract

We present 2 term newborn infants with apneic seizure originating in the occipital lobe that was diagnosed by video-EEG. One infant had ischemic infarction in the distribution of the posterior cerebral artery, extending to the cingulate gyrus. In the other infant, only transient occipital hyperechogenicity was observed by using neurosonography. In both cases, although the critical EEG discharge was observed at the occipital level, the infants presented no clinical manifestations. In patient 1, the discharge extended to the temporal lobe first, with subtle motor manifestations and tachycardia, then synchronously to both hemispheres (with bradypnea/hypopnea), and the background EEG activity became suppressed, at which point the infant experienced apnea. In patient 2, background EEG activity became suppressed right at the end of the focal discharge, coinciding with the appearance of apnea. In neither case did the clinical description by observers coincide with video-EEG findings. The existence of connections between the posterior limbic cortex and the temporal lobe and midbrain respiratory centers may explain the clinical symptoms recorded in these 2 cases. The novel features reported here include video-EEG capture of apneic seizure, ischemic lesion in the territory of the posterior cerebral artery as the cause of apneic seizure, and the appearance of apnea when the epileptiform ictal discharge extended to other cerebral areas or when EEG activity became suppressed. To date, none of these clinical findings have been previously reported. We believe this pathology may in fact be fairly common, but that video-EEG monitoring is essential for diagnosis.

Neonatal posterior cerebral artery stroke: clinical presentation, MRI findings, and outcome

“…Single‐channel amplitude‐integrated EEG did not show any ictal discharges, nor were there any clinical seizures. This clinical presentation is similar to two term infants with occipital injury, recently described by Castro Conde et al . In these two infants, the apnoeas were considered to be caused by involvement of the posterior limbic cortex, which connects to the temporal lobe and midbrain respiratory centres.…”

“…The incidence of PAIS in the territory of the posterior cerebral artery (PCA) is reported to occur in only 8 to 16% of all cases of PAIS . Although the aetiology, clinical presentation, and outcome of MCA stroke has been well described, data about PCA stroke are scarce …”

“…2 Although the aetiology, clinical presentation, and outcome of MCA stroke has been well described, data about PCA stroke are scarce. 3 The aim of the current study was to investigate infants with PAIS in the PCA territory and describe neuroimaging findings. Furthermore, we wanted to report the clinical presentation and follow-up data, including visual field defects.…”

The Puzzle of Apparent Life-Threatening Events in a Healthy Newborn

“…In the presence of consistent focal origin of seizures on EEG, and a normal cranial ultrasonogram as in our patient, a brain MRI is indicated to look for underlying structural lesions. 6 This case along with other reports 8 emphasize the importance of doing a polygraphic video-EEG monitoring in neonates with suspected apneic seizures in whom other causes of apnea have been excluded. As far as we know, this is the first report of a neonate with apneic seizures as the sole epileptic manifestation, caused by a cerebral developmental malformation.…”

Ictal Generalized EEG Attenuation (IGEA) and hypopnea in a child with occipital type 1 cortical dysplasia - Is it a biomarker for SUDEP?

“…(2012) had reported ictal bradypnea/hyponea associated with a complete suppression of the EEG activity in two infants with occipital lobe seizures. [ 11 ] The association of these ictal changes with occipital lobe seizures is yet to be understood. Systematic evaluation of various mechanisms involved in the causation of occipital lobe seizures, focal cortical dysplasia (FCD), seizure termination/electro-cerebral shut down, etc.…”