eprintid: 10042085 rev_number: 25 eprint_status: archive userid: 608 dir: disk0/10/04/20/85 datestamp: 2018-01-30 16:00:49 lastmod: 2021-09-19 22:18:24 status_changed: 2018-01-30 16:00:49 type: article metadata_visibility: show creators_name: Lacuey, N creators_name: Zonjy, B creators_name: Hampson, JP creators_name: Rani, MRS creators_name: Zaremba, A creators_name: Sainju, RK creators_name: Gehlbach, BK creators_name: Schuele, S creators_name: Friedman, D creators_name: Devinsky, O creators_name: Nei, M creators_name: Harper, RM creators_name: Allen, L creators_name: Diehl, B creators_name: Millichap, JJ creators_name: Bateman, L creators_name: Granner, MA creators_name: Dragon, DN creators_name: Richerson, GB creators_name: Lhatoo, SD title: The incidence and significance of periictal apnea in epileptic seizures ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D07 divisions: F81 keywords: apnea, breathing, seizures, sudden unexpected death in epilepsy, temporal epilepsy note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: OBJECTIVE: The aim of this study was to investigate periictal central apnea as a seizure semiological feature, its localizing value, and possible relationship with sudden unexpected death in epilepsy (SUDEP) pathomechanisms. METHODS: We prospectively studied polygraphic physiological responses, including inductance plethysmography, peripheral capillary oxygen saturation (SpO2 ), electrocardiography, and video electroencephalography (VEEG) in 473 patients in a multicenter study of SUDEP. Seizures were classified according to the International League Against Epilepsy (ILAE) 2017 seizure classification based on the most prominent clinical signs during VEEG. The putative epileptogenic zone was defined based on clinical history, seizure semiology, neuroimaging, and EEG. RESULTS: Complete datasets were available in 126 patients in 312 seizures. Ictal central apnea (ICA) occurred exclusively in focal epilepsy (51/109 patients [47%] and 103/312 seizures [36.5%]) (P < .001). ICA was the only clinical manifestation in 16/103 (16.5%) seizures, and preceded EEG seizure onset by 8 ± 4.9 s, in 56/103 (54.3%) seizures. ICA ≥60 s was associated with severe hypoxemia (SpO2 <75%). Focal onset impaired awareness (FOIA) motor onset with automatisms and FOA nonmotor onset semiologies were associated with ICA presence (P < .001), ICA duration (P = .002), and moderate/severe hypoxemia (P = .04). Temporal lobe epilepsy was highly associated with ICA in comparison to extratemporal epilepsy (P = .001) and frontal lobe epilepsy (P = .001). Isolated postictal central apnea was not seen; in 3/103 seizures (3%), ICA persisted into the postictal period. SIGNIFICANCE: ICA is a frequent, self-limiting semiological feature of focal epilepsy, often starting before surface EEG onset, and may be the only clinical manifestation of focal seizures. However, prolonged ICA (≥60 s) is associated with severe hypoxemia and may be a potential SUDEP biomarker. ICA is more frequently seen in temporal than extratemporal seizures, and in typical temporal seizure semiologies. ICA rarely persists after seizure end. ICA agnosia is typical, and thus it may remain unrecognized without polygraphic measurements that include breathing parameters. date: 2018-01-16 date_type: published official_url: http://dx.doi.org/10.1111/epi.14006 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green article_type_text: Journal Article verified: verified_manual elements_id: 1527924 doi: 10.1111/epi.14006 lyricists_name: Allen, Luke lyricists_name: Diehl, Beate lyricists_id: LAALL00 lyricists_id: BDIEH56 actors_name: Diehl, Beate actors_id: BDIEH56 actors_role: owner full_text_status: public publication: Epilepsia volume: 59 number: 3 pagerange: 573-582 event_location: United States issn: 1528-1167 citation: Lacuey, N; Zonjy, B; Hampson, JP; Rani, MRS; Zaremba, A; Sainju, RK; Gehlbach, BK; ... Lhatoo, SD; + view all <#> Lacuey, N; Zonjy, B; Hampson, JP; Rani, MRS; Zaremba, A; Sainju, RK; Gehlbach, BK; Schuele, S; Friedman, D; Devinsky, O; Nei, M; Harper, RM; Allen, L; Diehl, B; Millichap, JJ; Bateman, L; Granner, MA; Dragon, DN; Richerson, GB; Lhatoo, SD; - view fewer <#> (2018) The incidence and significance of periictal apnea in epileptic seizures. Epilepsia , 59 (3) pp. 573-582. 10.1111/epi.14006 <https://doi.org/10.1111/epi.14006>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10042085/1/Lacuey%20N%20Epilepsia%202018.pdf