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首页> 美国卫生研究院文献>Frontiers in Neurology >Incidence Recurrence and Risk Factors for Peri-ictal Central Apnea and Sudden Unexpected Death in Epilepsy
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Incidence Recurrence and Risk Factors for Peri-ictal Central Apnea and Sudden Unexpected Death in Epilepsy

机译：癫痫发作期间中枢性呼吸暂停和突发意外死亡的发生率复发率和危险因素

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>Introduction: Peri-ictal breathing dysfunction was proposed as a potential mechanism for SUDEP. We examined the incidence and risk factors for both ictal (ICA) and post-convulsive central apnea (PCCA) and their relationship with potential seizure severity biomarkers (i. e., post-ictal generalized EEG suppression (PGES) and recurrence.>Methods: Prospective, multi-center seizure monitoring study of autonomic, and breathing biomarkers of SUDEP in adults with intractable epilepsy and monitored seizures. Video EEG, thoraco-abdominal excursions, capillary oxygen saturation, and electrocardiography were analyzed. A subgroup analysis determined the incidences of recurrent ICA and PCCA in patients with ≥2 recorded seizures. We excluded status epilepticus and obscured/unavailable video. Central apnea (absence of thoracic-abdominal breathing movements) was defined as ≥1 missed breath, and ≥5 s. ICA referred to apnea preceding or occurring along with non-convulsive seizures (NCS) or apnea before generalized convulsive seizures (GCS).>Results: We analyzed 558 seizures in 218 patients (130 female); 321 seizures were NCS and 237 were GCS. ICA occurred in 180/487 (36.9%) seizures in 83/192 (43.2%) patients, all with focal epilepsy. Sleep state was related to presence of ICA [RR 1.33, CI 95% (1.08–1.64), p = 0.008] whereas extratemporal epilepsy was related to lower incidence of ICA [RR 0.58, CI 95% (0.37–0.90), p = 0.015]. ICA recurred in 45/60 (75%) patients. PCCA occurred in 41/228 (18%) of GCS in 30/134 (22.4%) patients, regardless of epilepsy type. Female sex [RR 11.30, CI 95% (4.50–28.34), p < 0.001] and ICA duration [RR 1.14 CI 95% (1.05–1.25), p = 0.001] were related to PCCA presence, whereas absence of PGES was related to absence of PCCA [0.27, CI 95% (0.16–0.47), p < 0.001]. PCCA duration was longer in males [HR 1.84, CI 95% (1.06–3.19), p = 0.003]. In 9/17 (52.9%) patients, PCCA was recurrent.>Conclusion: ICA incidence is almost twice the incidence of PCCA and is only seen in focal epilepsies, as opposed to PCCA, suggesting different pathophysiologies. ICA is likely to be a recurrent semiological phenomenon of cortical seizure discharge, whereas PCCA may be a reflection of brainstem dysfunction after GCS. Prolonged ICA or PCCA may, respectively, contribute to SUDEP, as evidenced by two cases we report. Further prospective cohort studies are needed to validate these hypotheses.
机译：>引言：有人认为，周期性呼吸功能障碍是SUDEP的潜在机制。我们检查了发作期（ICA）和惊厥后中枢性呼吸暂停（PCCA）的发生率和危险因素，以及它们与潜在的癫痫发作严重程度生物标志物（即发作后的广义EEG抑制（PGES）和复发的关系。>方法： 对难治性癫痫和癫痫发作的成年人SUDEP的自主性和呼吸生物标志物进行前瞻性，多中心癫痫监测研究，分析了视频EEG，胸腹腔偏移，毛细血管氧饱和度和心电图，确定了亚组分析≥2记录的癫痫发作中复发性ICA和PCCA的发生率。我们排除了癫痫持续状态和视频不清晰/不可用。中枢性呼吸暂停（无胸腹呼吸运动）定义为≥1次呼吸缺失和≥5 s。 >结果：我们分析了558 s 218名患者（130名女性）癫痫发作； NCS发作321次，GCS发作237次。 ICA发生在83/192（43.2％）的癫痫发作患者中，共180/487（36.9％），均伴有局灶性癫痫。睡眠状态与ICA的存在有关[RR 1.33，CI 95％（1.08–1.64），p = 0.008]，而颞外癫痫与ICA的发生率较低[RR 0.58，CI 95％（0.37–0.90），p = 0.015]。 ICA在45/60（75％）患者中复发。不论癫痫类型如何，在30/134（22.4％）的患者中，PCCA发生在41/228（18％）的GCS中。女性[RR 11.30，CI 95％（4.50–28.34），p <0.001]和ICA持续时间[RR 1.14 CI 95％（1.05–1.25），p = 0.001]与PCCA的存在有关，而PGES的缺乏与之相关至无PCCA [0.27，CI 95％（0.16-0.47），p <0.001]。男性的PCCA持续时间更长[HR 1.84，CI 95％（1.06-3.19），p = 0.003]。在9/17（52.9％）的患者中，PCCA复发。>结论： ICA发病率几乎是PCCA发病率的两倍，并且仅在局灶性癫痫发作中才见，这与PCCA相对，表明存在不同的病理生理学。 ICA可能是皮质癫痫发作的复发性符号学现象，而PCCA可能反映了GCS后脑干功能障碍。正如我们报告的两个案例所证明的，长时间的ICA或PCCA可能分别导致SUDEP。需要进一步的前瞻性队列研究来验证这些假设。

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