title: Hyperventilation revisited: physiological effects and efficacy on focal seizure activation in the era of video-EEG monitoring.
abstract: OBJECTIVE
  Hyperventilation is an activation method that provokes physiological slowing of brain rhythms, interictal discharges, and seizures, especially in generalized idiopathic epilepsies. In this study we assessed its effectiveness in inducing focal seizures during video-EEG monitoring.
  
  
  METHODS
  We analyzed the effects of hyperventilation (HV) during video-EEG monitoring (video-EEG) of patients with medically intractable focal epilepsies. We excluded children younger than 10 years, mentally retarded patients, and individuals with frequent seizures.
  
  
  RESULTS
  We analyzed 97 patients; 24 had positive seizure activation (PSA), and 73 had negative seizure activation (NSA). No differences were found between groups regarding sex, age, age at epilepsy onset, duration of epilepsy, frequency of seizures, and etiology. Temporal lobe epilepsies were significantly more activated than frontal lobe epilepsies. Spontaneous and activated seizures did not differ in terms of their clinical characteristics, and the activation did not affect the performance of ictal single-photon emission computed tomography (SPECT).
  
  
  CONCLUSIONS
  HV is a safe and effective method of seizure activation during monitoring. It does not modify any of the characteristics of the seizures and allows the obtaining of valuable ictal SPECTs. This observation is clinically relevant and suggests the effectiveness and the potential of HV in shortening the presurgical evaluation, especially of temporal lobe epilepsy patients, consequently reducing its costs and increasing the number of candidates for epilepsy surgery.
authors.affiliation: Epilepsy Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
authors.forename: Mirian S B
authors.initials: MS
authors.lastname: Guaranha
authors.forename: Eliana
authors.initials: E
authors.lastname: Garzon
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Buchpiguel
authors.forename: Sérgio
authors.initials: S
authors.lastname: Tazima
authors.forename: Elza M T
authors.initials: EM
authors.lastname: Yacubian
authors.forename: Américo C
authors.initials: AC
authors.lastname: Sakamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004569:Electroencephalography / Q000379:methods*; D004828:Epilepsies, Partial / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D012143:Respiratory Physiological Phenomena; D012189:Retrospective Studies; D014743:Videotape Recording / Q000379:methods*