The efficacy of routine hyperventilation for seizure activation during prolonged video-electroencephalography monitoring

The association of panic and hyperventilation with psychogenic non-epileptic seizures: A systematic review and meta-analysis

“…Abubakr et al retrospectively reviewed clinical records of PNES and epilepsy patients who underwent a routine, 3-min hyperventilation manoeuvre in an epilepsy monitoring unit [12]. Out of 16 PNES patients, six (37.5%) had a clinical event during hyperventilation or within 5 min following its completion.…”

“…Panic symptoms have been particularly commonly reported in PNES [8], and it has been claimed that panic plays a specific aetiological role in PNES events: Goldstein and Mellers speculated that the events occur as a response to heightened arousal in the absence of raised anxiety levels ('panic without panic') [9]. This is supported by reports of increased autonomic arousal in PNES [10], and by the use of hyperventilation, perhaps the cardinal feature of panic [11], to provoke non-epileptic events in EEG suites [12]. As the mechanisms of PNES remain elusive, the investigation of associated panic may potentially be informative as to their production or predisposition.…”

The Integrative Role of the Sigh in Psychology, Physiology, Pathology, and Neurobiology

“…Hyperventilation-induced seizures are another example of a brain state that may be centrally caused by the respiratory system (Tsiptsios et al, 2010; Yang et al, 2011). Although hyperventilation-induced seizure activation is a commonly used approach in electroconvulsive therapy (Datto et al, 2002; Haeck et al, 2011; Loo et al, 2010) or in the assessment of epilepsy (Abubakr et al, 2010; Jonas et al, 2011; Tsiptsios et al, 2010), we have very little mechanistic insight into how hyperventilation causes the seizures. It is generally believed that the seizure induction and duration relate to the degree of hypocapnia (Bergsholm et al, 1984), but when it comes to the existing data, the relationship between the level of hypocapnia and seizure activity is not always straightforward (Wirrell et al, 1996).…”

EEG in adults in the laboratory or at the patient's bedside

“…However, other studies report the absence of effectiveness for HPV stimulation procedure [7,68]. These differences can be explained by the heterogeneity of the populations studied and differences in methodology, especially regarding the duration of the HPV stimulation, which was six minutes for Jonas [83], five minutes for Holmes [68] and three minutes for Arain [13] and Abubakr [7]. Furthermore, hypocapnia and the importance of the blood flow to the brain seem to be crucial elements for the onset of HPV-induced EEG abnormalities [169].…”

“…Some studies have shown the effectiveness of HPV in triggering epileptic seizures, even more so when potentiated by antiepileptic drug withdrawal [83], and in promoting the onset of non-epileptic events [13]. However, other studies report the absence of effectiveness for HPV stimulation procedure [7,68]. These differences can be explained by the heterogeneity of the populations studied and differences in methodology, especially regarding the duration of the HPV stimulation, which was six minutes for Jonas [83], five minutes for Holmes [68] and three minutes for Arain [13] and Abubakr [7].…”