PT  - JOURNAL ARTICLE
AU  - Murugesan, Arun
AU  - Rani, M.R. Sandhya
AU  - Vilella, Laura
AU  - Lacuey, Nuria
AU  - Hampson, Johnson P.
AU  - Faingold, Carl L.
AU  - Friedman, Daniel
AU  - Devinsky, Orrin
AU  - Sainju, Rup K.
AU  - Schuele, Stephan
AU  - Diehl, Beate
AU  - Nei, Maromi
AU  - Harper, Ronald M.
AU  - Bateman, Lisa M.
AU  - Richerson, George
AU  - Lhatoo, Samden D.
TI  - Postictal serotonin levels are associated with peri-ictal apnea
AID  - 10.1212/WNL.0000000000008244
DP  - 2019 Oct 08
TA  - Neurology
PG  - e1485--e1494
VI  - 93
IP  - 15
4099  - http://n.neurology.org/content/93/15/e1485.short
4100  - http://n.neurology.org/content/93/15/e1485.full
SO  - Neurology2019 Oct 08; 93
AB  - Objective To determine the relationship between serum serotonin (5-HT) levels, ictal central apnea (ICA), and postconvulsive central apnea (PCCA) in epileptic seizures.Methods We prospectively evaluated video EEG, plethysmography, capillary oxygen saturation (SpO2), and ECG for 49 patients (49 seizures) enrolled in a multicenter study of sudden unexpected death in epilepsy (SUDEP). Postictal and interictal venous blood samples were collected after a clinical seizure for measurement of serum 5-HT levels. Seizures were classified according to the International League Against Epilepsy 2017 seizure classification. We analyzed seizures with and without ICA (n = 49) and generalized convulsive seizures (GCS) with and without PCCA (n = 27).Results Postictal serum 5-HT levels were increased over interictal levels for seizures without ICA (p = 0.01), compared to seizures with ICA (p = 0.21). In patients with GCS without PCCA, serum 5-HT levels were increased postictally compared to interictal levels (p < 0.001), but not in patients with seizures with PCCA (p = 0.22). Postictal minus interictal 5-HT levels also differed between the 2 groups with and without PCCA (p = 0.03). Increased heart rate was accompanied by increased serum 5-HT levels (postictal minus interictal) after seizures without PCCA (p = 0.03) compared to those with PCCA (p = 0.42).Conclusions The data suggest that significant seizure-related increases in serum 5-HT levels are associated with a lower incidence of seizure-related breathing dysfunction, and may reflect physiologic changes that confer a protective effect against deleterious phenomena leading to SUDEP. These results need to be confirmed with a larger sample size study.BBB=blood–brain barrier; BMI=body mass index; GCS=generalized convulsive seizures; HR=heart rate; ICA=ictal central apnea; PCCA=postconvulsive central apnea; PGES=postictal generalized EEG suppression; SRI=serotonin reuptake inhibitor; SUDEP=sudden unexpected death in epilepsy; VEEG=video EEG