Periictal cerebral tissue hypoxemia: A potential marker of SUDEP risk
Article first published online: 12 OCT 2012
Wiley Periodicals, Inc. © 2012 International League Against Epilepsy
Volume 53, Issue 12, pages e208–e211, December 2012
How to Cite
Moseley, B. D., Britton, J. W., Nelson, C., Lee, R. W. and So, E. (2012), Periictal cerebral tissue hypoxemia: A potential marker of SUDEP risk. Epilepsia, 53: e208–e211. doi: 10.1111/j.1528-1167.2012.03707.x
- Issue published online: 3 DEC 2012
- Article first published online: 12 OCT 2012
- Accepted August 16, 2012; Early View publication October 12, 2012.
- Cerebral oximetry;
- Sudden unexpected death in epilepsy
Cerebral oximetry has not been explored in patients experiencing seizures in the epilepsy monitoring unit (EMU). The purpose of our study was to evaluate the feasibility of periictal measurement of cerebral oxygenation using noninvasive cerebral tissue oximetry and to determine whether there was evidence of cerebral hypoxemia during generalized seizures. Cerebral oxygen saturation findings were subsequently correlated with sudden unexpected death in epilepsy (SUDEP) risk factors. We prospectively evaluated six patients admitted to our EMU with histories of generalized tonic–clonic seizures (GTCS) with prolonged scalp electroencephalography (EEG) and two regional cerebral oxygen saturation (rSO2) sensors. Minimum rSO2 values were recorded in the 5 min preceding seizure onset, during the seizure, and in the 5 min following seizure offset. SUDEP risk was assessed using the SUDEP-7 Inventory. Cerebral oximetry was well tolerated, with a mean duration of rSO2 monitoring of 81.1 h. Cerebral oxygen saturation data were available from at least one sensor in 9 (90%) of 10 seizures; only 6 (60%) of 10 seizures had useable periictal digital pulse oximetry data. GTCS were associated with significantly lower minimum ictal (p = 0.003) and postictal (p = 0.004) %rSO2 values than the minimum preictal value. Patients with at least one seizure with a %rSO2 decrease of ≥20% tended to have higher SUDEP-7 Inventory scores (mean SUDEP-7 Inventory score 7 ± 2.8) versus patients without recorded desaturations (4.3 ± 0.5, p = 0.08). Larger studies are needed to determine the value of cerebral oximetry in the identification of patients at risk of SUDEP.