Abstracts

Rationale: Sudden Unexpected Death in Epilepsy Patients (SUDEP) is an important cause of death in epilepsy patients. Role of cardio-pulmonary abnormalities in SUDEP is unclear in pediatric population. This study was done to assess cardio-pulmonary abnormalities during epileptic seizures in children, with the long-term goal of identifying potential mechanisms of SUDEP. Methods: We prospectively recorded and analyzed cardio-pulmonary abnormalities by pulse-oximetry, EKG and respiratory-inductance-plethysmography (RIP) during 101 seizures in 26 children. Logistic regression was done to evaluate association of these abnormalities with patient characteristics. Results: RIP provided data in 78% and pulse-oximetry in 63% seizures. Ictal-apnea increased with younger-age (p=0.01), male-gender (p=0.08) temporal-lobe (p=0.0005), left-sided (p=0.003), symptomatic-generalized (vs. primary-generalized and complex-partial) (p=0.01 and 0.08), complex-partial (vs. primary-generalized) (p=0.08), longer-duration seizures (p=0.0002), desaturation (p<0.0001), ictal-bradycardia (p=0.02), more antiepileptic-drugs (AEDs) (p=0.006) and decreased in frontal-lobe seizures (p=0.004). Ictal-bradypnea increased in temporal-lobe (p=0.07), left-sided (p=0.04), lesional (on MRI-brain) (p=0.09), symptomatic-generalized seizures (vs. complex-partial and primary-generalized) (p=0.005, 0.005), desaturation (p=0.07), more AEDs (p=0.07) and decreased in frontal-lobe seizures (p=0.07). Ictal-tachypnea increased in older-age (p=0.01), female-gender (p=0.05), frontal-lobe (vs. temporal and other foci) (p=0.09, 0.02), right-sided seizures (p=0.0008) less AEDs (p=0.005) and decreased in lesional (p=0.03) symptomatic-generalized seizures (vs. complex-partial and primary-generalized) (p=0.02, 0.03). Ictal-bradycardia increased in younger-age (p=0.09) male-gender (p=0.03) longer-duration seizures (p=0.03), desaturation (p=0.001), more AEDs (p=0.04), and decreased in frontal-lobe seizures (p=0.01). Ictal and post-ictal bradycardia were directly correlated (p=0.02). Ictal tachycardia increased in older-age (p=0.08), female-gender (p=0.001), frontal-lobe (p=0.06) seizures, and decreased with lesional-seizures (p=0.01) and more AEDs (p=0.02). Desaturation increased with longer-duration seizures (p<0.0001), ictal-apnea (p<0.0001), ictal-bradycardia (p=0.001), and more AEDs (p=0.001). Conclusions: Potentially life-threatening cardio-pulmonary abnormalities like bradycardia, apnea and hypoxemia in pediatric epileptic seizures are associated with predictable patient and seizure characteristics, including seizure sub-type and duration. Understanding epidemiology of cardio-pulmonary compromise in epilepsy patients may lead to preventative strategies for patients at high-risk for SUDEP.