TY - JOUR
T1 - Postictal stertor
T2 - Associations with focal and bilateral seizure types
AU - Carmenate, Yaretson I.
AU - Gutierrez, Erie G.
AU - Kang, Joon Y.
AU - Krauss, Gregory L.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/9
Y1 - 2020/9
N2 - Objective: The objective of the present study was to determine the association between respiratory stertor and focal and bilateral seizure types. Methods: We characterized ictal and postictal behaviors during symmetric bilateral tonic–clonic (TC) and asymmetric TC seizures in the Johns Hopkins University (JHU) epilepsy monitoring unit, comparing these to focal unaware seizures. We measured the presence and duration of postictal stertorous respirations, postictal generalized electroencephalographic suppression (PGES), immobility/motor dysfunction, and encephalopathy and determined their associations and relationship to seizure types. Results: In initial seizures recorded in 80 consecutive patients, bilateral symmetric TC seizures (N = 35) were strongly associated with PGES (97%, p < 0.001) and postictal stertorous respirations (89%, p < 0.001). Only 10% of the 20 patients with asymmetric TC seizures had brief PGES; focal unaware seizures (N = 25) were not associated with PGES or stertorous breathing. Some patients (24%) with asymmetric or bilateral symmetric TC seizures had severe postictal encephalopathy with stertor that was separate or extended beyond periods of PGES. Conclusion: Bilateral symmetric TC seizures, but not focal unaware seizures, have postictal stertor during PGES. Severe postictal encephalopathy, however, is also associated with motor dysfunction and stertor. Stertor appears to be a compensatory postictal respiratory pattern for ictal/postictal hypoxemia and occurs with PGES or postictal encephalopathy.
AB - Objective: The objective of the present study was to determine the association between respiratory stertor and focal and bilateral seizure types. Methods: We characterized ictal and postictal behaviors during symmetric bilateral tonic–clonic (TC) and asymmetric TC seizures in the Johns Hopkins University (JHU) epilepsy monitoring unit, comparing these to focal unaware seizures. We measured the presence and duration of postictal stertorous respirations, postictal generalized electroencephalographic suppression (PGES), immobility/motor dysfunction, and encephalopathy and determined their associations and relationship to seizure types. Results: In initial seizures recorded in 80 consecutive patients, bilateral symmetric TC seizures (N = 35) were strongly associated with PGES (97%, p < 0.001) and postictal stertorous respirations (89%, p < 0.001). Only 10% of the 20 patients with asymmetric TC seizures had brief PGES; focal unaware seizures (N = 25) were not associated with PGES or stertorous breathing. Some patients (24%) with asymmetric or bilateral symmetric TC seizures had severe postictal encephalopathy with stertor that was separate or extended beyond periods of PGES. Conclusion: Bilateral symmetric TC seizures, but not focal unaware seizures, have postictal stertor during PGES. Severe postictal encephalopathy, however, is also associated with motor dysfunction and stertor. Stertor appears to be a compensatory postictal respiratory pattern for ictal/postictal hypoxemia and occurs with PGES or postictal encephalopathy.
KW - Asymmetric TC seizures
KW - SUDEP
KW - Stertor
KW - Tonic–clonic seizures
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U2 - 10.1016/j.yebeh.2020.107103
DO - 10.1016/j.yebeh.2020.107103
M3 - Article
C2 - 32460174
AN - SCOPUS:85085053191
SN - 1525-5050
VL - 110
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
M1 - 107103
ER -