title: Postictal generalized EEG suppression: an inconsistent finding in people with multiple seizures.
abstract: OBJECTIVE
  To determine the consistency and facilitating cofactors of postictal generalized EEG suppression (PGES) of >20 seconds after convulsive seizures (CS), a suggested predictor of sudden unexpected death in epilepsy risk.
  
  
  METHODS
  We retrospectively reviewed video-EEG data of people with ≥2 recorded CS. Presence and duration of PGES were assessed by 2 independent observers blinded to patient status. Intraindividual consistency of PGES >20 seconds was determined and correlations with clinical characteristics were analyzed after correction for individual effects and the varying number of seizures.
  
  
  RESULTS
  One hundred fifty-four seizures in 59 people were analyzed. PGES >20 seconds was found in 37 individuals (63%) and 57 (37%) of CS. The proportion of persons in whom PGES occurred consistently (presence or absence of PGES >20 seconds in all CS) was lower in those with more CS. PGES of >20 seconds was more frequent in seizures arising from sleep (odds ratio 3.29, 95% confidence interval 1.21-8.96) and when antiepileptic medication was tapered (odds ratio 4.80, 95% confidence interval 1.27-18.14).
  
  
  CONCLUSIONS
  Apparent PGES consistency was less frequent in people with more CS recorded, suggesting that PGES is an inconsistent finding in any one individual. Thus, we believe that PGES >20 seconds is not a reliable predictor of sudden unexpected death in epilepsy. Sleep and antiepileptic drug reduction appear to facilitate the occurrence of PGES.
authors: From the SEIN-Stichting Epilepsie Instellingen Nederland (R.J.L., A.G., J.W.S., R.D.T.), Heemstede, the Netherlands; NIHR University College London Hospitals Biomedical Research Centre (J.W.S., R.D.T.), UCL Institute of Neurology, Queen Square, London, and Epilepsy Society, Chalfont St. Peter, UK; Department of Epileptology (C.E.E., R.S.), University Hospital Bonn, Germany; and Department of Neurology (R.D.T.), LUMC Leiden University Medical Center, Leiden, the Netherlands.
authors: Robert J
authors: RJ
authors: Lamberts
authors: Athanasios
authors: A
authors: Gaitatzis
authors: Josemir W
authors: JW
authors: Sander
authors: Christian E
authors: CE
authors: Elger
authors: Rainer
authors: R
authors: Surges
authors: Roland D
authors: RD
authors: Thijs
mesh_terms: D000328:Adult; D003645:Death, Sudden / Q000209:etiology*; D004569:Electroencephalography / Q000295:instrumentation / Q000379:methods*; D004827:Epilepsy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000503:physiopathology*; D016037:Single-Blind Method; D013997:Time Factors
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