Partial Seizures Manifesting As Apnea Only in an Adult

Abstract

Summary:Purpose: Although several cases of apneic seizures have been reported in neonates, epileptic seizures presenting as apnea only in adults are very rare. We present a case report of a 19-year-old man with viral encephalitis and frequent episodes of apneic seizures.Methods: Prolonged electroencephalograms (EEGs), repiratory monitorings, and imaging including ictal-interictal subtraction single photon emission computed tomography (SPECT) coregistered with magnetic resonance imaging (MRI) were performed.Results: Ictal EEGs recorded during apneic episodes showed repetitive sharp waves or rhythmic theta activity arising from the left or right independent bitemporal region. Ictal SPECT was performed during one episode of apnea that showed ictal EEG discharges arising from the left posterior temporal area. Ictal-interictal subtraction SPECT coregistered with MRI revealed that the seizures originated from the left, posterior, midlateral temporal cortex.Conclusions: Previous studies with ictal EEG or brain stimulation suggest that apneic seizures might be mediated through the limbic and associated cortical systems. Our study reports on a very rare case of partial seizures with apnea only in an adult patient and is supported by ictal EEG and ictal-interictal subtraction SPECT coregistered with MRI. Key Words: Apneic seizure-Encephalitis-Limbic-Temporal lobe-Subtraction SPECT.Although respiratory arrest or compromise often accompanies various types of seizures, apnea can occur as an isolated ictal manifestation (1). Breath-holding spells are common, especially in preterm or sick newborns with various underlying disorders. Because seizures are not well organized in newborns, however, newborns with apnea should be examined for other signs of convulsive disorders as differentiated from other nonconvulsive causes of apneic attacks (2-7). A few cases of isolated apneic seizures, which usually last 1-2 min and can be documented by ictal electroencephalography (EEG) (8), have been reported in children. In contrast, seizures with apnea only are quite rare in adults, with only a few studies reporting that respiratory arrest or apnea can be produced by stimulation of some brain structures in experimental animals and humans (9-11).Our study is a case report of a 19-year-old man with viral encephalitis and frequent attacks of apneic seizures that were documented by continuous EEG and respiraAccepted June 2, 1999. Address correspondence and reprint requests to Dr. S. B. Hong at Epilepsy Center, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Seoul, Korea. tory monitoring as well as ictal-interictal subtraction single proton emission computed tomography (SPECT) coregistered with magnetic resonance imaging (MRI). CASE REPORTA 19-year-old man was first seen in the emergency room of a local hospital with status epilepticus on February 17, 1998. He had neither a family history nor a medical history of seizures and had been healthy until then. After several days of flu-like symptoms, ...

Cerebral vasomotor reactivity in epilepsy patients

“…On the other hand, partial seizures without respiratory muscle contraction that manifest with apnea have been reported [13]. Although several cortical-subcortical regions were suggested to be responsible for central apnea, the exact region responsible for ictal epileptic apnea is not well defined [12].…”

Nocturnal Frontal Lobe Epilepsy Presenting as Obstructive Type Sleep Apnea

“…Apnea during a seizure may be due to muscle contraction of the respiratory muscles or reduced central breathing drive (central apnea). Most of the case reports regarding apneic seizures are of the central apnoea type 2,3. However, in this case, the apnoea was of the obstructive type, which may have been caused by tonic contraction of the respiratory muscles.…”

“…NFLE has a variable semiology, but apnea is very rare 7. Most observations suggest that respiratory irregularities are most likely caused by dysfunctions of the temporal lobe and limbic system 2,3,5,8. And the apneas were central type.…”

Sudden unexpected death in epilepsy: Fatal post-ictal respiratory and arousal mechanisms

“…There are a few reported cases of SUDEP or near SUDEP in hospital EMUs (Bateman et al, 2010b; Bird, 1997; Dasheiff Rm, 1986; Lee HW, 1999; McLean and Wimalaratna, 2007), which have provided us the most relevant information available about the mechanisms of death. However, even in these rare cases, although it has been common to make firm conclusions about the causes of death (Tomson et al, 2008), the actual cause of death is not completely clear in many cases, because breathing was assessed solely by visual inspection, a method that is notoriously inaccurate for measurement of ventilation.…”