Protocols for multimodal polygraphy for cardiorespiratory monitoring in the epilepsy monitoring unit. Part II – Research acquisition

Hupp, Norma J.; Talavera, Blanca; Melius, Stephen; Lacuey, Nuria; Lhatoo, Samden D.

doi:10.1016/j.eplepsyres.2022.106987

Cited by 5 publications

(5 citation statements)

References 50 publications

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“…We used pressure transducer airflow signal to quantify respiratory responses. The pressure sensor allows both nasal and oral breathing signal measurements 13 . Breathing was quantified to estimate relative change in the nasal airflow waveforms to assess effects on breathing rate (BR), tidal volume (TV), and minute ventilation (MV).…”

Section: Methodsmentioning

confidence: 99%

Stimulation‐induced respiratory enhancement in corticothalamic regions

Talavera¹,

Chaitanya²,

Hupp³

et al. 2023

Epilepsia

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Objective We aimed to identify corticothalamic areas and electrical stimulation paradigms that optimally enhance breathing. Methods Twenty‐nine patients with medically intractable epilepsy were prospectively recruited in an epilepsy monitoring unit while undergoing stereoelectroencephalographic evaluation. Direct electrical stimulation in cortical and thalamic regions was carried out using low (<1 Hz) and high (≥10 Hz) frequencies, and low (<5 mA) and high (≥5 mA) current intensities, with pulse width of .1 ms. Electrocardiography, arterial oxygen saturation (SpO2), end‐tidal carbon dioxide (ETCO2), oronasal airflow, and abdominal and thoracic plethysmography were monitored continuously during stimulations. Airflow signal was used to estimate breathing rate, tidal volume, and minute ventilation (MV) changes during stimulation, compared to baseline. Results Electrical stimulation increased MV in the amygdala, anterior cingulate, anterior insula, temporal pole, and thalamus, with an average increase in MV of 20.8% ± 28.9% (range = 0.2%–165.6%) in 19 patients. MV changes were associated with SpO2 and ETCO2 changes (p < .001). Effects on respiration were parameter and site dependent. Within amygdala, low‐frequency stimulation of the medial region produced 78.49% greater MV change (p < .001) compared to high‐frequency stimulation. Longer stimulation produced greater MV changes (an increase of 4.47% in MV for every additional 10 s, p = .04). Significance Stimulation of amygdala, anterior cingulate gyrus, anterior insula, temporal pole, and thalamus, using certain stimulation paradigms, enhances respiration. Among tested paradigms, low‐frequency, low‐intensity, long‐duration stimulation of the medial amygdala is the most effective breathing enhancement stimulation strategy. Such approaches may pave the way for the future development of neuromodulatory techniques that aid rescue from seizure‐related apnea, potentially as a targeted sudden unexpected death in epilepsy prevention method.

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Section: Methodsmentioning

confidence: 99%

Stimulation‐induced respiratory enhancement in corticothalamic regions

Talavera¹,

Chaitanya²,

Hupp³

et al. 2023

Epilepsia

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“…Electrocardiogram (EKG), pulsioximetry, and inductance plethysmography acquisition were performed using previously described methodology. 6,7,16,21-23…”

Section: Methodsmentioning

confidence: 99%

“…Electrocardiogram (EKG), pulsioximetry, and inductance plethysmography acquisition were performed using previously described methodology. 6,7,16,[21][22][23] We analyzed a 2-minute period before clinical or electrographic seizure onset (preictal period), the ictal period (limited to the available technically satisfactory portions of the recording), and 3 minutes after clinical seizure end (postconvulsive period). For the preictal and postconvulsive periods, if EKG data were lost or had an artifact for >6 consecutive seconds, the full period was disregarded.…”

Section: Cardiorespiratory and Veeg Monitoringmentioning

confidence: 99%

Incidence and Types of Cardiac Arrhythmias in the Peri-Ictal Period in Patients Having a Generalized Convulsive Seizure

Vilella,

Miyake,

Chaitanya

et al. 2024

Neurology

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Background and ObjectivesGeneralized convulsive seizures (GCSs) are the main risk factor of sudden unexpected death in epilepsy (SUDEP), which is likely due to peri-ictal cardiorespiratory dysfunction. The incidence of GCS-induced cardiac arrhythmias, their relationship to seizure severity markers, and their role in SUDEP physiopathology are unknown. The aim of this study was to analyze the incidence of seizure-induced cardiac arrhythmias, their association with electroclinical features and seizure severity biomarkers, as well as their specific occurrences in SUDEP cases. MethodsThis is an observational, prospective, multicenter study of patients with epilepsy aged 18 years and older with recorded GCS during inpatient video-EEG monitoring for epilepsy evaluation. Exclusion criteria were status epilepticus and an obscured video recording. We analyzed semiologic and cardiorespiratory features through video-EEG (VEEG), electrocardiogram, thoracoabdominal bands, and pulse oximetry. We investigated the presence of bradycardia, asystole, supraventricular tachyarrhythmias (SVTs), premature atrial beats, premature ventricular beats, nonsustained ventricular tachycardia (NSVT), atrial fibrillation (Afib), ventricular fibrillation (VF), atrioventricular block (AVB), exaggerated sinus arrhythmia (ESA), and exaggerated sinus arrhythmia with bradycardia (ESAWB). A board-certified cardiac electrophysiologist diagnosed and classified the arrhythmia types. Bradycardia, asystole, SVT, NSVT, Afib, VF, AVB, and ESAWB were classified as arrhythmias of interest because these were of SUDEP pathophysiology value. The main outcome was the occurrence of seizure-induced arrhythmias of interest during inpatient VEEG monitoring. Moreover, yearly follow-up was conducted to identify SUDEP cases. Binary logistic generalized estimating equations were used to determine clinical-demographic and peri-ictal variables that were predictive of the presence of seizure-induced arrhythmias of interest. The z-score test for 2 population proportions was used to test whether the proportion of seizures and patients with postconvulsive ESAWB or bradycardia differed between SUDEP cases and survivors. ResultsThis study includes data from 249 patients (mean age 37.2 ± 23.5 years, 55% female) who had 455 seizures. The most common arrhythmia was ESA, with an incidence of 137 of 382 seizures

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“…They include medications (e.g. naloxone), 10,30 multimodal monitoring in the epilepsy monitoring unit, 38 seizure diaries, 39 diaphragmatic pacing, 10 and the use of machine learning and individualized SUDEP risk prediction tools. 12…”

Section: Future Prevention Strategiesmentioning

confidence: 99%

Sudden unexpected death in epilepsy in children

Whitney

Sharma

RamachandranNair

2023

Develop Med Child Neuro

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Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy‐related mortality in children and adults living with epilepsy. The incidence of SUDEP is comparable in both children and adults; it is approximately 1.2 per 1000 person years. The pathophysiology of SUDEP is not well understood but may involve mechanisms such as cerebral shutdown, autonomic dysfunction, altered brainstem function, and cardiorespiratory demise. Risk factors for SUDEP include the presence of generalized tonic–clonic seizures, nocturnal seizures, possible genetic predisposition, and non‐adherence to antiseizure medications. Pediatric‐specific risk factors are not fully elucidated. Despite recommendations from consensus guidelines, many clinicians still do not follow the practice of counseling their patients about SUDEP. SUDEP prevention has been an area of important research focus and includes several strategies, such as obtaining seizure control, optimizing treatment regimens, nocturnal supervision, and seizure detection devices. This review discusses what is currently known about SUDEP risk factors and reviews current and future preventive strategies for SUDEP.

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Protocols for multimodal polygraphy for cardiorespiratory monitoring in the epilepsy monitoring unit. Part II – Research acquisition

Cited by 5 publications

References 50 publications

Stimulation‐induced respiratory enhancement in corticothalamic regions

Stimulation‐induced respiratory enhancement in corticothalamic regions

Incidence and Types of Cardiac Arrhythmias in the Peri-Ictal Period in Patients Having a Generalized Convulsive Seizure

Sudden unexpected death in epilepsy in children

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