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Dynamics of convulsive seizure termination and postictal generalized EEG suppression

Bauer, PR; Thijs, RD; Lamberts, RJ; Velis, DN; Visser, GH; Tolner, EA; Sander, JW; ... Kalitzin, SN; + view all (2017) Dynamics of convulsive seizure termination and postictal generalized EEG suppression. Brain , 140 (3) pp. 655-668. 10.1093/brain/aww322. Green open access

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Abstract

It is not fully understood how seizures terminate and why some seizures are followed by a period of complete brain activity suppression, postictal generalized EEG suppression. This is clinically relevant as there is a potential association between postictal generalized EEG suppression, cardiorespiratory arrest and sudden death following a seizure. We combined human encephalographic seizure data with data of a computational model of seizures to elucidate the neuronal network dynamics underlying seizure termination and the postictal generalized EEG suppression state. A multi-unit computational neural mass model of epileptic seizure termination and postictal recovery was developed. The model provided three predictions that were validated in EEG recordings of 48 convulsive seizures from 48 subjects with refractory focal epilepsy (20 females, age range 15-61 years). The duration of ictal and postictal generalized EEG suppression periods in human EEG followed a gamma probability distribution indicative of a deterministic process (shape parameter 2.6 and 1.5, respectively) as predicted by the model. In the model and in humans, the time between two clonic bursts increased exponentially from the start of the clonic phase of the seizure. The terminal interclonic interval, calculated using the projected terminal value of the log-linear fit of the clonic frequency decrease was correlated with the presence and duration of postictal suppression. The projected terminal interclonic interval explained 41% of the variation in postictal generalized EEG suppression duration (P < 0.02). Conversely, postictal generalized EEG suppression duration explained 34% of the variation in the last interclonic interval duration. Our findings suggest that postictal generalized EEG suppression is a separate brain state and that seizure termination is a plastic and autonomous process, reflected in increased duration of interclonic intervals that determine the duration of postictal generalized EEG suppression.

Type: Article
Title: Dynamics of convulsive seizure termination and postictal generalized EEG suppression
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/brain/aww322
Publisher version: https://doi.org/10.1093/brain/aww322
Language: English
Additional information: This is a pre-copyedited, author-produced PDF of an article accepted for publication in Brain following peer review. The version of record Prisca R. Bauer, Roland D. Thijs, Robert J. Lamberts, Demetrios N. Velis, Gerhard H. Visser, Else A. Tolner, Josemir W. Sander, Fernando H. Lopes da Silva, Stiliyan N. Kalitzin; Dynamics of convulsive seizure termination and postictal generalized EEG suppression. Brain 2017, is available online at: http://dx.doi.org/10.1093/brain/aww322
Keywords: SUDEP, clonic slowing, critical slowing down, epilepsy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Experimental Epilepsy
URI: https://discovery.ucl.ac.uk/id/eprint/1535477
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