Nuria Lacuey1, Rita Martins2, Laura Vilella3, Johnson P Hampson4, M R Sandhya Rani3, Kingman Strohl5, Anita Zaremba3, Jaison S Hampson3, Rup K Sainju6, Daniel Friedman7, Maromi Nei8, Catherine Scott9, Brian K Gehlbach6, Norma J Hupp3, Stephan Schuele10, Jennifer Ogren11, Ronald M Harper12, Luke Allen9, Beate Diehl9, Lisa M Bateman13, Orrin Devinsky7, George B Richerson6, Samden Lhatoo14. 1. Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: nurialacuey@yahoo.es. 2. Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal. 3. NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA. 4. Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. 5. Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Medical Center, Cleveland, OH, USA. 6. NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA; University of Iowa Carver College of Medicine, Iowa City, IA, USA. 7. NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA; NYU Langone School of Medicine, New York, NY, USA. 8. NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA. 9. NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA; Institute of Neurology, University College London, London, UK. 10. NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA; Northwestern University, Feinberg School of Medicine, Chicago, USA. 11. NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA; Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA. 12. Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal; Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA. 13. NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA; Department of Neurology, Columbia University, New York, NY, USA. 14. Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA.
Abstract
OBJECTIVE: Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy. METHODS: Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group. RESULTS: Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05). CONCLUSIONS: Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
OBJECTIVE: Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy. METHODS: Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group. RESULTS: Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05). CONCLUSIONS: Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
Authors: Colin B Josephson; Arturo Gonzalez-Izquierdo; Spiros Denaxas; Natalie K Fitzpatrick; Tolulope T Sajobi; Jordan D T Engbers; Scott Patten; Nathalie Jette; Samuel Wiebe Journal: Epilepsia Date: 2017-09-24 Impact factor: 5.864
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Authors: Laura Vilella; Nuria Lacuey; Johnson P Hampson; M R Sandhya Rani; Rup K Sainju; Daniel Friedman; Maromi Nei; Kingman Strohl; Catherine Scott; Brian K Gehlbach; Bilal Zonjy; Norma J Hupp; Anita Zaremba; Nassim Shafiabadi; Xiuhe Zhao; Victoria Reick-Mitrisin; Stephan Schuele; Jennifer Ogren; Ronald M Harper; Beate Diehl; Lisa Bateman; Orrin Devinsky; George B Richerson; Philippe Ryvlin; Samden D Lhatoo Journal: Neurology Date: 2018-12-19 Impact factor: 11.800
Authors: Cory A Massey; Samantha J Thompson; Ryan W Ostrom; Janice Drabek; Olafur A Sveinsson; Torbjörn Tomson; Elisabeth A Haas; Othon J Mena; Alica M Goldman; Jeffrey L Noebels Journal: Brain Commun Date: 2021-07-09
Authors: Johnson P Hampson; Nuria Lacuey; Mrs Sandhya Rani; Jaison S Hampson; Kristina A Simeone; Timothy A Simeone; Ponnada A Narayana; Louis Lemieux; Samden D Lhatoo Journal: Front Neurol Date: 2022-07-07 Impact factor: 4.086
Authors: Smriti Patodia; Alyma Somani; Joan Liu; Alice Cattaneo; Beatrice Paradiso; Maria Garcia; Muhammad Othman; Beate Diehl; Orrin Devinsky; James D Mills; Jackie Foong; Maria Thom Journal: Brain Pathol Date: 2022-04-27 Impact factor: 7.611