Ictal Central Apnea (ICA) may be a useful semiological sign in invasive epilepsy surgery evaluations

Copyright © 2019 Elsevier B.V. All rights reserved..

INTRODUCTION: Ictal central apnea (ICA) occurs in up to 44% focal seizures (temporal > extratemporal) and precedes scalp electrographic (EEG) seizure onset in 54% of them. Central apnea can be elicited by electrical stimulation of mesial temporal structures (amygdala, hippocampus, and anteromesial parahippocampal and fusiform gyri), known symptomatogenic anatomical substrates for ICA. We aimed to analyze ICA value as an early semiological sign in invasive evaluation of suspected mesial temporal lobe epilepsy (MTLE).

METHODS: We examined seizure records of intractable, suspected MTLE patients undergoing intracranial EEG (ICEEG) evaluations who had simultaneous respiratory belts with artifact-free signal.

RESULTS: We analyzed 32 seizures (11 patients). ICA was seen in 22/32 (68.7%) seizures in 9 patients, was the first clinical manifestation in all of them, and the only clinical sign in 5/32 (15.6%). ICA onset occurred simultaneously or after ICEEG seizure onset in 20/22 (91%) seizures by 4.9 +4.6 [0-14] seconds. In one patient with bilateral amygdalar and hippocampal implantation, ICA occurred before ICEEG seizure onset, indicating seizure discharge in an untargeted, probably extra amygdalohippocampal, symptomatogenic location.

CONCLUSIONS: ICA incidence in mesial temporal lobe (MTL) seizures is 68.7%. ICA is often the first clinical sign and sometimes the only clinical manifestation in MTLE, but usually goes unrecognized. ICA recognition may help anatomo-electro-clinical localization of clinical seizure onset to known symptomatogenic areas. ICA preceding ICEEG onset may indicate inadequate putative epileptogenic zone coverage, and may impact surgical outcomes. Respiratory monitoring in surgical evaluations is of critical importance and should be carried out as standard of care.

Medienart:

E-Artikel

Erscheinungsjahr:

2019

Erschienen:

2019

Enthalten in:

Zur Gesamtaufnahme - volume:156

Enthalten in:

Epilepsy research - 156(2019) vom: 15. Okt., Seite 106164

Sprache:

Englisch

Beteiligte Personen:

Lacuey, Nuria [VerfasserIn]
Hupp, Normal J [VerfasserIn]
Hampson, Johnson [VerfasserIn]
Lhatoo, Samden [VerfasserIn]

Links:

Volltext

Themen:

Apnea
Breathing
Epilepsy
Journal Article
Seizures
Semiology
Surgery
Temporal lobe epilepsy

Anmerkungen:

Date Completed 22.07.2020

Date Revised 22.07.2020

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1016/j.eplepsyres.2019.106164

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM299428540