Drs. Singh and Katz contributed equally to this work and are the co-first authors in this study.
Full-Length Original Research
Cardiopulmonary complications during pediatric seizures: A prelude to understanding SUDEP
Article first published online: 5 APR 2013
Wiley Periodicals, Inc. © 2013 International League Against Epilepsy
Volume 54, Issue 6, pages 1083–1091, June 2013
How to Cite
Singh, K., Katz, E. S., Zarowski, M., Loddenkemper, T., Llewellyn, N., Manganaro, S., Gregas, M., Pavlova, M. and Kothare, S. V. (2013), Cardiopulmonary complications during pediatric seizures: A prelude to understanding SUDEP. Epilepsia, 54: 1083–1091. doi: 10.1111/epi.12153
Drs. Pavlova and Kothare contributed equally to this work and are the co-last authors in this study.
- Issue published online: 4 JUN 2013
- Article first published online: 5 APR 2013
- Manuscript Accepted: 16 FEB 2013
- Harvard Catalyst. Grant Number: UL1 RR 025758
- Eisai Inc.
- Epilepsy Foundation of America
- Epileptic seizures;
- SUDEP ;
- Respiratory complications;
- Cardiac complications
Sudden unexpected death in epilepsy (SUDEP) is an important, unexplained cause of death in epilepsy. Role of cardiopulmonary abnormalities in the pathophysiology of SUDEP is unclear in the pediatric population. Our objective was to assess cardiopulmonary abnormalities during epileptic seizures in children, with the long-term goal of identifying potential mechanisms of SUDEP.
We prospectively recorded cardiopulmonary functions using pulse-oximetry, electrocardiography (ECG), and respiratory inductance plethysmography (RIP). Logistic regression was used to evaluate association of cardiorespiratory findings with seizure characteristics and demographics.
We recorded 101 seizures in 26 children (average age 3.9 years). RIP provided analyzable data in 78% and pulse-oximetry in 63% seizures. Ictal central apnea was more prevalent in patients with younger age (p = 0.01), temporal lobe (p < 0.001), left-sided (p < 0.01), symptomatic generalized (p = 0.01), longer duration seizures (p < 0.0002), desaturation (p < 0.0001), ictal bradycardia (p < 0.05), and more antiepileptic drugs (AEDs; p < 0.01), and was less prevalent in frontal lobe seizures (p < 0.01). Ictal bradypnea was more prevalent in left-sided (p < 0.05), symptomatic generalized seizures (p < 0.01), and in brain magnetic resonance imaging (MRI) lesions (p < 0.1). Ictal tachypnea was more prevalent in older-age (p = 0.01), female gender (p = 0.05), frontal lobe (p < 0.05), right-sided seizures (p < 0.001), fewer AEDs (p < 0.01), and less prevalent in lesional (p < 0.05) and symptomatic generalized seizures (p < 0.05). Ictal bradycardia was more prevalent in male patients (p < 0.05) longer duration seizures (p < 0.05), desaturation (p = 0.001), and more AEDs (p < 0.05), and was less prevalent in frontal lobe seizures (p = 0.01). Ictal and postictal bradycardia were directly associated (p < 0.05). Desaturation was more prevalent in longer-duration seizures (p < 0.0001), ictal apnea (p < 0.0001), ictal bradycardia (p = 0.001), and more AEDs (p = 0.001).
Potentially life-threatening cardiopulmonary abnormalities such as bradycardia, apnea, and hypoxemia in pediatric epileptic seizures are associated with predictable patient and seizure characteristics, including seizure subtype and duration.