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Postictal generalized EEG suppression

Wanchat Theeranaew, James McDonald, Bilal Zonjy, Farhad Kaffashi, Brian D Moseley, Daniel Friedman, Elson So, James Tao, Maromi Nei, Philippe Ryvlin, Rainer Surges, Roland Thijs, Stephan Schuele, Samden Lhatoo, Kenneth A Loparo
Although there is no strict consensus, some studies have reported that Postictal generalized EEG suppression (PGES) is a potential electroencephalographic (EEG) biomarker for risk of sudden unexpected death in epilepsy (SUDEP). PGES is an epoch of EEG inactivity after a seizure, and the detection of PGES in clinical data is extremely difficult due to artifacts from breathing, movement and muscle activity that can adversely affect the quality of the recorded EEG data. Even clinical experts visually interpreting the EEG will have diverse opinions on the start and end of PGES for a given patient...
February 2018: IEEE Transactions on Bio-medical Engineering
Kazuo Okanari, Hiroshi Otsubo, Elizabeth Kouzmitcheva, Jagadish Rangrej, Shiro Baba, Ayako Ochi, Tohru Okanishi, Yoichiro Homma, Dragos A Nita, Elizabeth J Donner
BACKGROUND: The identification of a biomarker for sudden unexpected death in epilepsy (SUDEP) has the potential to save lives. Generalized convulsive seizures and postictal generalized suppression on electroencephalography (EEG) most often precede sudden unexpected death in epilepsy (SUDEP) and are potential biomarkers. We identify the EEG and seizure characteristics associated with postictal generalized EEG suppression in children with epilepsy. METHODS: Video EEGs were reviewed for seizure type, duration and semiology, and electrographic features...
July 4, 2017: Pediatric Neurology
Véronique Latreille, Myriam Abdennadher, Barbara A Dworetzky, Judith Ramel, David White, Eliot Katz, Marcin Zarowski, Sanjeev Kothare, Milena Pavlova
Patients with epilepsy have 20-fold risk of sudden death when compared to the general population. Uncontrolled seizures is the most consistent risk factor, and death often occurs at night or in relation to sleep. We examined seizure-related respiratory disturbances in sleep versus wakefulness, focusing on periictal oxygen saturation. Respiratory measures were examined in 48 recorded seizures (sleep, n = 23, wake, n = 25) from 20 adult patients with epilepsy. Seizures from sleep were associated with lower saturation, as compared to seizures from wakefulness, both during ictal (sleep median = 90...
September 2017: Epilepsia
Lang Jin, Ying Zhang, Xiao-Li Wang, Wen-Juan Zhang, Yong-Hong Liu, Zhao Jiang
Sudden unexpected death in epilepsy (SUDEP) is one of the most frequent causes of death among patients with epilepsy. Most SUDEP or near-SUDEP are unwitnessed and not observed or recorded during video-EEG recording in epilepsy monitoring units. This report describes a young woman with post ictal apnea and generalized EEG suppression (PGES) after a secondary generalized tonic-clonic seizure (sGTCS). This was accompanied by bradycardia and then ventricular tachycardia (VT). But at the end of VT, the patient's breath recovered without any intervention, such as cardio-respiratory resuscitation...
September 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Weifeng Peng, Jessica L Danison, Masud Seyal
OBJECTIVE: Sudden unexpected death in epilepsy (SUDEP) is a common cause of death in epilepsy and frequently occurs following generalized tonic-clonic seizures (GTCS) in sleep. Postictal generalized electroencephalography (EEG) suppression (PGES), postictal immobility, and periictal respiratory dysfunction are potential risk factors for SUDEP. We sought to determine whether there was a difference in respiratory dysfunction, PGES, and postictal immobility for GTCS occurring during wakefulness or sleep...
August 2017: Epilepsia
Prisca R Bauer, Roland D Thijs, Robert J Lamberts, Demetrios N Velis, Gerhard H Visser, Else A Tolner, Josemir W Sander, Fernando H Lopes da Silva, Stiliyan N Kalitzin
It is not fully understood how seizures terminate and why some seizures are followed by a period of complete brain activity suppression, postictal generalized EEG suppression. This is clinically relevant as there is a potential association between postictal generalized EEG suppression, cardiorespiratory arrest and sudden death following a seizure. We combined human encephalographic seizure data with data of a computational model of seizures to elucidate the neuronal network dynamics underlying seizure termination and the postictal generalized EEG suppression state...
March 1, 2017: Brain: a Journal of Neurology
Sylvain Rheims, Luc Valton, Véronique Michel, Louis Maillard, Vincent Navarro, Philippe Convers, Fabrice Bartolomei, Arnaud Biraben, Arielle Crespel, Philippe Derambure, Bertrand de Toffol, Edouard Hirsch, Philippe Kahane, Martine Lemesle Martin, Didier Tourniaire, Sébastien Boulogne, Catherine Mercier, Pascal Roy, Philippe Ryvlin
BACKGROUND: Generalized tonic-clonic seizures (GTCSs) are the main risk factor for sudden unexpected death in epilepsy (SUDEP). Experimental and clinical data strongly suggest that the majority of SUDEP results from a postictal respiratory dysfunction progressing to terminal apnea. Postictal apnea could partly derive from a seizure-induced massive release of endogenous opioids. The main objective of this study is to evaluate the efficacy of an opioid antagonist, naloxone, administered in the immediate aftermath of a GTCS, in reducing the severity of the postictal central respiratory dysfunction...
November 3, 2016: Trials
Dirk-Matthias Altenmüller, Andreas Schulze-Bonhage, Christian E Elger, Rainer Surges
OBJECTIVES: Postictal generalized EEG suppression (PGES) frequently occurs after generalized convulsive seizures (GCS) and may be involved in the pathophysiology of sudden unexpected death in epilepsy (SUDEP). It is usually determined using conventional scalp EEG which is likely to miss cerebral activity in deeper brain structures. Here, we examined intracranial EEG activity after GCS to unravel the pattern and extent of local brain activity during apparent PGES on scalp EEG (s-PGES)...
September 2016: Epilepsy & Behavior: E&B
Stiliyan N Kalitzin, Prisca R Bauer, Robert J Lamberts, Demetrios N Velis, Roland D Thijs, Fernando H Lopes Da Silva
Automated monitoring and alerting for adverse events in people with epilepsy can provide higher security and quality of life for those who suffer from this debilitating condition. Recently, we found a relation between clonic slowing at the end of a convulsive seizure (CS) and the occurrence and duration of a subsequent period of postictal generalized EEG suppression (PGES). Prolonged periods of PGES can be predicted by the amount of progressive increase of interclonic intervals (ICIs) during the seizure. The purpose of the present study is to develop an automated, remote video sensing-based algorithm for real-time detection of significant clonic slowing that can be used to alert for PGES...
December 2016: International Journal of Neural Systems
Samden D Lhatoo, Maromi Nei, Manoj Raghavan, Michael Sperling, Bilal Zonjy, Nuria Lacuey, Orrin Devinsky
OBJECTIVE: To describe the phenomenology of monitored sudden unexpected death in epilepsy (SUDEP) occurring in the interictal period where death occurs without a seizure preceding it. METHODS: We report a case series of monitored definite and probable SUDEP where no electroclinical evidence of underlying seizures was found preceding death. RESULTS: Three patients (two definite and one probable) had SUDEP. They had a typical high SUDEP risk profile with longstanding intractable epilepsy and frequent generalized tonic-clonic seizures (GTCS)...
July 2016: Epilepsia
Alison M Pack
No abstract text is available yet for this article.
March 2016: Epilepsy Currents
James X Tao
No abstract text is available yet for this article.
March 22, 2016: Neurology
Shasha Wu, Naoum P Issa, Sandra L Rose, Ahmer Ali, James X Tao
OBJECTIVES: The objective of this study was to determine the impact of periictal nurse interventions on postictal generalized EEG suppression (PGES) in generalized convulsive seizures (GCS). METHODS: We retrospectively reviewed the video-EEG recordings of patients during long-term video-EEG monitoring. We compared the duration of seizures, seizure phases (tonic, clonic, and tonic-clonic phases), and the occurrence and duration of postictal generalized EEG suppression (PGES) in patients with and without periictal interventions (e...
May 2016: Epilepsy & Behavior: E&B
Jiahui Xu, Bo Jin, Jianwei Yan, Jing Wang, Jingying Hu, Zhongjin Wang, Zhong Chen, Meiping Ding, Shuhua Chen, Shuang Wang
OBJECTIVE: The aim of this study is to investigate the key facilitating factors for postictal generalized EEG suppression (PGES) in a large cohort of patients with generalized convulsive seizures (GCSs). METHODS: We retrospectively reviewed the data of consecutive patients who had GCSs in the epilepsy monitoring units of two epilepsy centers. Statistical analysis was performed to assess specific variables as potential risk factors for PGES. RESULTS: Among the 208 enrolled patients with 366 seizures, PGES was observed in 109 (51...
April 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Jonathan Kuo, Wenjie Zhao, Chin-Shang Li, Jeffrey D Kennedy, Masud Seyal
OBJECTIVE: The pathophysiology of sudden unexpected death in epilepsy (SUDEP) remains undetermined. Seizures are accompanied by respiratory dysfunction (RD). Postictal generalized electroencephalography (EEG) suppression (PGES) may follow generalized tonic-clonic seizures (GTCS). Following GTCS patients have impaired arousal and may be motionless. Patients with SUDEP are usually prone. Postictal immobility (PI) may contribute to SUDEP by not permitting repositioning of the head to allow unimpeded ventilation...
March 2016: Epilepsia
Brian D Moseley, Christopher M DeGiorgio
To help identify patients at greatest risk for sudden unexpected death in epilepsy (SUDEP), screening inventories like the SUDEP-7 Inventory can be useful. In this study, we examined the strength of association between this inventory's risk factors and postictal generalized EEG suppression (PGES), a biomarker of SUDEP risk. We reanalyzed data from an epilepsy monitoring unit study of 37 children. We performed a 2 by 2 contingency table analysis to determine the association between "yes" responses on the inventory questions and PGES following >=1 seizure...
November 2015: Epilepsy Research
Veriano Alexandre, Blanca Mercedes, Luc Valton, Louis Maillard, Fabrice Bartolomei, William Szurhaj, Edouard Hirsch, Cécile Marchal, Francine Chassoux, Jérôme Petit, Arielle Crespel, Anca Nica, Vincent Navarro, Philippe Kahane, Bertrand De Toffol, Pierre Thomas, Sarah Rosenberg, Marie Denuelle, Jacques Jonas, Philippe Ryvlin, Sylvain Rheims
OBJECTIVE: To identify the clinical determinants of occurrence of postictal generalized EEG suppression (PGES) after generalized convulsive seizures (GCS). METHODS: We reviewed the video-EEG recordings of 417 patients included in the REPO2MSE study, a multicenter prospective cohort study of patients with drug-resistant focal epilepsy. According to ictal semiology, we classified GCS into 3 types: tonic-clonic GCS with bilateral and symmetric tonic arm extension (type 1), clonic GCS without tonic arm extension or flexion (type 2), and GCS with unilateral or asymmetric tonic arm extension or flexion (type 3)...
November 3, 2015: Neurology
Jeffrey D Kennedy, Kimberly A Hardin, Palak Parikh, Chin-Shang Li, Masud Seyal
PURPOSE: Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. METHODS: Chest X-Rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression...
April 2015: Seizure: the Journal of the British Epilepsy Association
Sanjeev Rajakulendran, Lina Nashef
Sudden unexpected death in epilepsy (SUDEP) remains a leading cause of epilepsy-related death, and yet, its pathogenic mechanisms remain ill-defined. Although epidemiological studies of SUDEP in heterogenous populations have established a number of clinical associations, evaluation and stratification of individual risk remains difficult. Thus, potential markers as predictors of risk of SUDEP are important not only clinically but also for research on SUDEP prevention. Recordings from rare monitored cases of SUDEP demonstrate postictal generalized EEG suppression after terminal seizures, raising expectations that postictal generalized EEG suppression may identify individuals at higher risk...
February 2015: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Brian D Moseley
Although sudden unexpected death in epilepsy is encountered less frequently in children versus adults, it is still an important direct epilepsy-related cause of death in this population. Just as in adults, the pathophysiology of sudden unexpected death in epilepsy in children is believed to involve seizure-related autonomic dysfunction. Seizures that develop during the pediatric period can be marked by some of the most dramatic alterations in autonomic functions seen at any age. This article reviews such seizure-related autonomic changes, including ictal nausea/emesis, hypersalivation, hypoxemia, apnea, tachycardia, bradycardia, cardiac repolarization anomalies, reduced heart rate variability, and postictal generalized EEG suppression...
February 2015: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
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