title: Periictal autonomic dysfunction and generalized postictal EEG suppression in convulsive seizures arising from sleep and wakefulness.
abstract: Sleep appears to be an independent risk factor of sudden unexpected death in epilepsy (SUDEP). We retrospectively determined the periictal electrophysiological characteristics of nocturnal and diurnal generalized convulsive seizures (GCSs) in 109 patients. Our data showed that preictal heart rate (HR) was significantly lower in 46 patients with nocturnal GCSs than in 63 patients with diurnal GCSs (p=0.002). However, there was no significant difference in postictal HR and respiratory rate (RR), total seizure duration, total convulsive phase, tonic phase, and clonic phase. Meanwhile, postictal generalized EEG suppression (PGES) was observed in 52.4% of the patients with diurnal GCSs and 67.4% of the patients with nocturnal GCSs. Duration of PGES was 38.2±17.3s in patients with diurnal GCSs and 49.5±21.7s in patients with nocturnal GCSs. There was also no significant difference in the prevalence (p=0.118) and duration (p=0.044, Bonferroni-corrected significant level: α=0.00625) of PGES in the two patient groups. Therefore, there is no clear evidence to attribute the SUDEP risk associated with sleep to postictal autonomic dysfunction and PGES, as compared to wakefulness.
authors.affiliation: Department of Neurology, The University of Chicago, Chicago, IL 60637, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lee
authors.forename: Shasha
authors.initials: S
authors.lastname: Wu
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Zhou
authors.forename: Jennifer
authors.initials: J
authors.lastname: Liebenthal
authors.forename: Sandra
authors.initials: S
authors.lastname: Rose
authors.forename: James X
authors.initials: JX
authors.lastname: Tao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D004569:Electroencephalography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012890:Sleep; D014851:Wakefulness / Q000502:physiology*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Autonomic dysfunction; Convulsive seizures; EEG suppression; SUDEP; Sleep