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Abstract
Objective To identify which cortical regions are associated with direct electrical stimulation (DES)–induced alteration of breathing significant enough to impair pulse oximetry (SpO2).
Methods Evolution of SpO2 after 1,352 DES was analyzed in 75 patients with refractory focal epilepsy who underwent stereo-EEG recordings. For each DES, we assessed the change in SpO2 from 30 seconds prior to DES onset to 120 seconds following the end of the DES. The primary outcome was occurrence of stimulation-induced transient hypoxemia as defined by decrease of SpO2 ≥5% within 60 seconds after stimulation onset as compared to pre-DES SpO2 or SpO2 nadir <90% during at least 5 seconds. Localization of the stimulated contacts was defined according to MarsAtlas brain parcellation and Freesurfer segmentation.
Results A stimulation-induced transient hypoxemia was observed after 16 DES (1.2%) in 10 patients (13%), including 6 in whom SpO2 nadir was <90%. Among these 16 DES, 7 (44%) were localized within the perisylvian cortex. After correction for individual effects and the varying number of DES contributed by each person, significant decrease of SpO2 was significantly associated with the localization of DES (p = 0.019).
Conclusion Though rare, a significant decrease of SpO2 could be elicited by cortical direct electrical stimulation outside the temporo-limbic structures, most commonly after stimulation of the perisylvian cortex.
Glossary
- CI=
- confidence interval;
- DES=
- direct electrical stimulation;
- GCS=
- generalized convulsive seizures;
- OR=
- odds ratio;
- SA-SDQ=
- Sleep Apnea Scale of the Sleep Disorders Questionnaire;
- SEEG=
- stereo-EEG;
- SITH=
- stimulation-induced transient hypoxemia;
- SUDEP=
- sudden and unexpected death in epilepsy;
- THdesat=
- desaturation threshold
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received May 20, 2019.
- Accepted in final form November 26, 2019.
- © 2020 American Academy of Neurology
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