Abstracts

Rationale: Apnea is a common non-specific symptom in neonates, but can accompany seizures. We set out to delineate isolated respiratory arrest as an epileptic phenomenon and to describe its EEG features and clinical associations. Methods: Retrospective review of medical records and direct review of long-term video EEG polygraphic recordings, including EKG and respiration monitoring of neonatal patients at the University of California, San Francisco between January 2008 and December 2014. Results: Ictal apnea was recorded in 7 neonates, manifesting as isolated respiratory arrest time-locked to electrographic seizure. Duration ranged between 80 and 120 seconds, apnea persisted during the whole duration of the electrographic discharge and was not accompanied by other clinical symptoms such as tonic posturing or by changes in baseline heart rate. In 7 additional infants who presented with recurrent isolated apnea, only electrographic seizures were subsequently recorded. All neonates were 35 weeks or older and 12/14 were term. Ictal onset was in the left or right temporal and/or occipital leads and the underlying focal pathology (hemorrhagic stroke (6), focal ischemic stroke (4), diffuse/multifocal infarction or HIE (3) and polymicrogyria (1)) invariably included the perisylvian regions. Conclusions: Isolated apnea may represent a distinct seizure type in neonates. EEG monitoring should be performed in the setting of prolonged and recurrent apneas without bradycardia in term neonates as this seizure type may be the only manifestation of perinatal stroke in the nursery. Funding: N/A