RT Journal Article
SR Electronic
T1 Hypoxemia following generalized convulsive seizures
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e183
OP e193
DO 10.1212/WNL.0000000000006777
VO 92
IS 3
A1 Rheims, Sylvain
A1 Alvarez, Blanca Mercedes
A1 Alexandre, Veriano
A1 Curot, Jonathan
A1 Maillard, Louis
A1 Bartolomei, Fabrice
A1 Derambure, Philippe
A1 Hirsch, Edouard
A1 Michel, Véronique
A1 Chassoux, Francine
A1 Tourniaire, Didier
A1 Crespel, Arielle
A1 Biraben, Arnaud
A1 Navarro, Vincent
A1 Kahane, Philippe
A1 De Toffol, Bertrand
A1 Thomas, Pierre
A1 Rosenberg, Sarah
A1 Valton, Luc
A1 Bezin, Laurent
A1 Ryvlin, Philippe
A1 ,
YR 2019
UL http://n.neurology.org/content/92/3/e183.abstract
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