Respiratory Arrest From Seizure Discharges in Limbic System

Nelson, Dewey A.

doi:10.1001/archneur.1968.00480020085008

Cited by 76 publications

(27 citation statements)

References 11 publications

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“…Spindle activity, such as that seen immediately postoperatively in Case 2, was frequently observed by Meldrum and Brierley during the recovery from hypotension. Nelson and Ray 27 reported a case of reversible ischemia in which there was spindle-like activity similar to that seen in Case 2 of this study. This is the only other similar case of post-ischemic EEG spindling in the human, although many authors have observed it in animal studies and one showed that it originates in n. amygdalae.…”

Section: Figure 10supporting

confidence: 73%

Hypotension-Induced Changes in Cerebral Function During Cardiac Surgery

Stockard

Bickford

Myers

et al. 1974

Stroke

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HypotensionInduced Changes in Cerebral Function During Cardiac Surgery• In a series of 75 patients undergoing cardiac operations with the assistance of cardiopulmonary bypass (CPB), 15 patients were subjected to relatively large hypotensive stresses during CPB as measured by the depth and duration of the fall in cerebral perfusion pressure. Of these 15 patients, eight manifested cerebral dysfunction postoperatively ranging from temporary exacerbation of pre-existing focal neurological deficits to irreversible coma. In each of these eight cases, EEG disturbances which first appeared at the time of hypotensive episodes during CPB persisted postoperatively and correlated with the nature and evolution of the clinical deficit. In two of the patients who did not regain consciousness postoperatively, neuropathological studies revealed bilateral laminar cortical necrosis, primarily involving cerebral cortex in one case and cerebellar cortex in the other, with accentuation in arterial border zones. Of seven other patients who suffered comparable exposures to hypotension during CPB, none evidenced cerebral dysfunction postoperatively. The most important determinants of this selective vulnerability to low extracorporeal perfusion pressure appeared to be the "reperfusion" pressure established after the hypotensive episode, postoperative blood pressure and cardiac output, and brain temperature at the time of the hypotension. Advanced age and history of cerebrovascular insufficiency were the greatest risk factors among patient variables. Despite these advances, however, postoperative neurological morbidity remains a frequent sequel to operations involving cardiopulmonary bypass (CPB). Numerous studies have incriminated pump-generated microemboli as a major factor in these neurological sequelae 2 -3 while other reports have emphasized the role of adverse situational aspects of recovery such as lack of sleep and sensory deprivation. Additional Key Words -5Other investigators who correlated histological evidence of ischemic anoxia following CPB with extracorporeal perfusion pressure have suggested that hypotension during CPB may also contribute to CNS dysfunction following cardiac surgery. "10 However, in none of these studies was the intraoperative blood pressure recorded continuously and, in the only one in which the EEG was monitored during bypass, 9 the EEG findings were not discussed. Thus, there was no direct evidence that low perfusion pressures were responsible for the ischemia which produced the lesions in these studies.From the Departments of Neurosciences, Surgery and Anesthesiology, University of California, San Diego, La Jolla, California 92037.More direct evidence was provided in a preliminary study in which six of seven patients having severe hypotensive episodes during CPB developed irreversible or slowly resolving EEG abnormalities during the episodes which later correlated with clinical or pathological evidence of cerebral damage. 11Although the important role of intraoperative hypotension in the neur...

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Section: Figure 10supporting

confidence: 73%

Hypotension-Induced Changes in Cerebral Function During Cardiac Surgery

Stockard

Bickford

Myers

et al. 1974

Stroke

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“…When sufficiently long, alteration or loss of consciousness follows. Polygraphic monitoring of respiratory movements (pneumogram), the electroencephalogram (EEG), and the electrocardiogram (EKG) shows that the apneic periods do not represent childhood epileptic apnea (Coulter, 1984;Nelson & Ray, 1968;Watanabe et al, 1982). Monitoring also shows that there are two types of CRS, leading to asphyxic-hypoxic and ischemic-hypoxic attacks (Gastaut, 1984).…”

Section: Of Compulsive Respiratory Stereotypiesmentioning

confidence: 99%

Compulsive respiratory stereotypies in children with autistic features: Polygraphic recording and treatment with fenfluramine

Gastaut¹,

Rufo²

1987

J Autism Dev Disord

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Syncopes due to compulsive respiratory stereotypies were studied in eight patients with autistic features. Most had been referred for episodes thought to be intractable epileptic seizures. Polygraphic recording showed two types of syncope, one induced by prolonged apnea and the other by a prolonged Valsalva maneuver. Fenfluramine, 1.5-3 mg/kg per day, was given in an open trial. In four of five cases with frequent Valsalva maneuvers, respiratory stereotypies and syncopes were suppressed for 2-18 months. Patients with periodic apneas were more severely retarded and had less clear benefit. Side effects consisted of dose-dependent sedation and mild weight loss which stabilized without interrupting treatment. We suggest that these syncopes are volitional and may be associated with pleasant sensations. A double-blind placebo-controlled trial of fenfluramine seems warranted in such patients.

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“…'6 [18][19][20][21][22] Apnoea is known to occur during seizures,'8 [23][24][25][26][27] but systematic studies of ictal respiratory changes in adults are few. We set out to assess the yield and feasibility of routinely applying polysomnography techniques to seizure recordings in patients undergoing EEG/videotelemetry.…”

mentioning

confidence: 99%

Apnoea and bradycardia during epileptic seizures: relation to sudden death in epilepsy.

Nashef

Walker²,

Allen³

et al. 1996

Journal of Neurology, Neurosurgery & Psychiatry

345

273

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Objective-To record non-invasively ictal cardiorespiratory variables. Methods-Techniques employed in polysomnography were used in patients with epilepsy undergoing EEG-video recording at a telemetry unit. Results-Apnoea (> 10, range > 10-63, mean 24 s) was seen in 20 of 47 clinical seizures (three secondary generalised, 16 complex partial, and one tonic) and 10 of 17 patients. Apnoea was central in 10 patients, but obstructive apnoea was also recorded in three of 10. Oxyhaemoglobin saturation (Spo,) dropped to less than 85% in 10 seizures (six patients). An increase in heart rate was common (91% of seizures). Bradycardia/sinus arrest was documented in four patients (mean maximum RR interval 5 36, range 2-8-8-6 s) but always in the context of a change in respiratory pattern. Conclusion-Ictal apnoea was often seen. The occurrence ofbradycardia in association with apnoea suggests the involvement of cardiorespiratory reflexes. Similar mechanisms may operate in cases of sudden death in epilepsy.

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Respiratory Arrest From Seizure Discharges in Limbic System

Cited by 76 publications

References 11 publications

Hypotension-Induced Changes in Cerebral Function During Cardiac Surgery

Hypotension-Induced Changes in Cerebral Function During Cardiac Surgery

Compulsive respiratory stereotypies in children with autistic features: Polygraphic recording and treatment with fenfluramine

Apnoea and bradycardia during epileptic seizures: relation to sudden death in epilepsy.

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