Jonathan Liu1, Joseph S Peedicail1, Ismael Gaxiola-Valdez1, Emmy Li1, Victoria Mosher1, William Wilson1, Tefani Perera1, Shaily Singh1, G Campbell Teskey1, Paolo Federico2. 1. From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada. 2. From Hotchkiss Brain Institute (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., G.C.T., P.F.), Seaman Family MR Research Centre (J.L., J.S.P., I.G.-V., E.L., V.M., W.W., T.P., S.S., P.F.), Department of Clinical Neurosciences (J.S.P., S.S., P.F.), and Department of Radiology (P.F.), Cumming School of Medicine, University of Calgary, Canada. pfederic@ucalgary.ca.
Abstract
OBJECTIVE: Since the strongest risk factor for sudden unexpected death in epilepsy (SUDEP) is frequent bilateral tonic-clonic seizures (BTCS), our aim was to determine whether postictal hypoperfusion in brainstem respiratory centers (BRCs) is more common following tonic-clonic seizures. METHODS: We studied 21 patients with focal epilepsies who underwent perfusion imaging with arterial spin labeling MRI. Subtraction maps of cerebral blood flow were obtained from the postictal and baseline scans. We identified 6 regions of interest in the brainstem that contain key BRCs. Patients were considered to have postictal BRC hypoperfusion if any of the 6 regions of interest were significantly hypoperfused. RESULTS: All 6 patients who experienced BTCS during the study had significant clusters of postictal hypoperfusion in BRCs compared to 7 who had focal impaired awareness seizures (7/15). The association between seizure type studied and the presence of BRC hypoperfusion was significant. Duration of epilepsy and frequency of BTCS were not associated with postictal brainstem hypoperfusion despite also being associated with risk for SUDEP. CONCLUSION: Postictal hypoperfusion in brainstem respiratory centers occurs more often following BTCS than other seizure types, providing a possible explanation for the increased risk of SUDEP in patients who regularly experience BTCS.
OBJECTIVE: Since the strongest risk factor for sudden unexpected death in epilepsy (SUDEP) is frequent bilateral tonic-clonic seizures (BTCS), our aim was to determine whether postictal hypoperfusion in brainstem respiratory centers (BRCs) is more common following tonic-clonic seizures. METHODS: We studied 21 patients with focal epilepsies who underwent perfusion imaging with arterial spin labeling MRI. Subtraction maps of cerebral blood flow were obtained from the postictal and baseline scans. We identified 6 regions of interest in the brainstem that contain key BRCs. Patients were considered to have postictal BRC hypoperfusion if any of the 6 regions of interest were significantly hypoperfused. RESULTS: All 6 patients who experienced BTCS during the study had significant clusters of postictal hypoperfusion in BRCs compared to 7 who had focal impaired awareness seizures (7/15). The association between seizure type studied and the presence of BRC hypoperfusion was significant. Duration of epilepsy and frequency of BTCS were not associated with postictal brainstem hypoperfusion despite also being associated with risk for SUDEP. CONCLUSION: Postictal hypoperfusion in brainstem respiratory centers occurs more often following BTCS than other seizure types, providing a possible explanation for the increased risk of SUDEP in patients who regularly experience BTCS.
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