Neurology Medical News about temporal lobe seizure, apnea, hypercapnia, hypoxemia, sudden unexpected death in epilepsy

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Ictal apnea linked to contralateral spread of temporal lobe seizures: Intracranial EEG recordings in refractory temporal lobe epilepsy
Epilepsia, 08/24/09

Seyal M et al. – Findings show a close temporal relationship between spread of seizures to the contralateral hemisphere and the onset of seizure-associated apnea. Apnea onsets are more closely linked to time of contralateral spread than to time of seizure onset. Temporal lobe epilepsy (TLE) pts with evidence of contralateral seizure spread may be at higher risk for ictal-related respiratory dysfunction vs pts with seizures that remain unilateral.

Methods

Study of the temporal relationship between ictal apnea and seizure onset and spread in pts undergoing video-EEG (electroencephalography) telemetry (VET) with intracranial electrodes
Assessment of 10 TLE pts undergoing VET
Evaluation of data from synchronously recorded digital pulse oximetry (SaO2), end-tidal CO2 (ETCO2), nasal airflow, abdominal excursions, and electrocardiography

Results

Of 61 captured seizures, SaO2 in ictal/postictal period available for 52 seizures, apnea onset times for 27 seizures, and ETCO2 for 16 seizures
Apneas occurred only when seizures spread to contralateral temporal lobe
Mean delay to apnea onset significantly shorter after contralateral seizure spread (2.87 s) vs seizure onset (58.4 s)
Mean SaO2 nadir with partial seizures or partial seizures prior to secondary generalization: 89.4 ± 8.6% (91.5, 69–100)
After generalized convulsions, mean oxygen saturation nadir: 75.8 ± 10.6% (78.5, 58–90)
ETCO2 elevations occurred with each ictal desaturation <85%

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