Multimodality peak lctal vital signs during video-EEG monitoring.
OBJECTIVE
To assess and compare peak, multimodal ictal vital signs (iVS) during epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES).


METHODS
Between 4/1/2010 and 4/1/2011, 183 adults had video-EEG monitoring, with 96 consecutive patients meeting inclusion criteria. Heart rate (HR), oxygen saturation (SaO2), and blood pressure (BP) were obtained at baseline and during an ictus. The motor semiology of each ES and PNES was also assessed. Student t-test, Fischer's Test, Wilcoxon Test (p=<0.05), and linear regression provided statistical correlation.


RESULTS
The 46 patients with ES and 50 patients with PNES had similar baseline VS. Generalized tonic-clonic ES had the highest absolute iVS. ES yielded a higher absolute ictal HR (p=0.0004) and lower SaO2 nadir (p=0.003) than PNES. Systolic and diastolic BP did not differ between groups (p=NS). The upper ranges of iS-BP attained a maximum value of 195/135mm Hg in ES and 208/128mmHg in PNES. For ES, the change in ictal HR was inversely correlated with a reduction in ictal SaO2 (CC= -0.4; p=0.003). In PNES, ictal HR correlated with systolic BP (CC=0.6; p=<0.0001), but not ictal SaO2.


CONCLUSIONS
The inverse relationship between ictal HR and ictal SaO2 in ES suggests a neurobiological difference, and the concept of intrinsic cardio-respiratory dysfunction in patients with epilepsy. The significantly raised peak elevations in ictal HR and ictal systolic BP during PNES demonstrates the potential for serious adverse outcomes if attacks are prolonged.
Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA. Electronic address: Tatum.william@mayo.edu.
William O
WO
Tatum
University of Pennsylvania, Philadelphia, PA, USA.
Emily K
EK
Acton
College of Medicine, University of Miami, Miami, FL, USA.
Michael E
ME
Langston
Department of Clinical Neurophysiology, Mayo Clinic, Jacksonville, FL, USA.
Kirsten
K
Yelvington
Department of Nursing, Mayo Clinic, Jacksonville, FL, USA.
Cammi
C
Bowman
Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA.
Jerry J
JJ
Shih
Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA.
William P
WP
Cheshire
D000328:Adult; D004569:Electroencephalography / Q000379:methods*; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064926:Neurophysiological Monitoring / Q000379:methods*; D010101:Oxygen Consumption / Q000502:physiology*; D011602:Psychophysiologic Disorders / Q000175:diagnosis*; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology*; D014741:Video Recording
Epileptic; Heart rate; Nonepileptic; Oxygen saturation; Seizure