PT  - JOURNAL ARTICLE
AU  - Rheims, Sylvain
AU  - Alvarez, Blanca Mercedes
AU  - Alexandre, Veriano
AU  - Curot, Jonathan
AU  - Maillard, Louis
AU  - Bartolomei, Fabrice
AU  - Derambure, Philippe
AU  - Hirsch, Edouard
AU  - Michel, Véronique
AU  - Chassoux, Francine
AU  - Tourniaire, Didier
AU  - Crespel, Arielle
AU  - Biraben, Arnaud
AU  - Navarro, Vincent
AU  - Kahane, Philippe
AU  - De Toffol, Bertrand
AU  - Thomas, Pierre
AU  - Rosenberg, Sarah
AU  - Valton, Luc
AU  - Bezin, Laurent
AU  - Ryvlin, Philippe
AU  - ,
TI  - Hypoxemia following generalized convulsive seizures
AID  - 10.1212/WNL.0000000000006777
DP  - 2019 Jan 15
TA  - Neurology
PG  - e183--e193
VI  - 92
IP  - 3
4099  - http://n.neurology.org/content/92/3/e183.short
4100  - http://n.neurology.org/content/92/3/e183.full
SO  - Neurology2019 Jan 15; 92
AB  - Objective To analyze the factors that determine the occurrence or severity of postictal hypoxemia in the immediate aftermath of a generalized convulsive seizure (GCS).Methods We reviewed the video-EEG recordings of 1,006 patients with drug-resistant focal epilepsy included in the REPO2MSE study to identify those with ≥1 GCS and pulse oximetry (SpO2) measurement. Factors determining recovery of SpO2 ≥ 90% were investigated using Cox proportional hazards models. Association between SpO2 nadir and person- or seizure-specific variables was analyzed after correction for individual effects and the varying number of seizures.Results A total of 107 GCS in 73 patients were analyzed. A transient hypoxemia was observed in 92 GCS (86%). Rate of GCS with SpO2 <70% dropped from 40% to 21% when oxygen was administered early (p = 0.046). Early recovery of SpO2 ≥90% was associated with early administration of oxygen (p = 0.004), absence of postictal generalized EEG suppression (PGES) (p = 0.014), and extratemporal lobe epilepsy (p = 0.001). Lack of early administration of O2 (p = 0.003), occurrence of PGES (p = 0.018), and occurrence of ictal hypoxemia during the focal phase (p = 0.022) were associated with lower SpO2 nadir.Conclusion Postictal hypoxemia was observed in the immediate aftermath of nearly all GCS but administration of oxygen had a strong preventive effect. Severity of postictal hypoxemia was greater in temporal lobe epilepsy and when hypoxemia was already observed before the onset of secondary GCS.BMI=body mass index; CI=confidence interval; EMU=epilepsy monitoring unit; GCS=generalized convulsive seizure; PGES=postictal generalized EEG suppression; SUDEP=sudden unexpected death in epilepsy