Seizure Clusters, Seizure Severity Markers, and SUDEP Risk.

Authors

• Manuela Ochoa-Urrea, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Nuria Lacuey, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Laura Vilella, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Liang Zhu, Biostatistics & Epidemiology Research Design Core, Division of Clinical and Translational Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Shirin Jamal-Omidi, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• M R Sandhya Rani, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Johnson P Hampson, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Mojtaba Dayyani, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Jaison Hampson, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Norma J Hupp, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Shiqiang Tao, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Rup K Sainju, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; University of Iowa Carver College of Medicine, Iowa City, IA, United States
• Daniel Friedman, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; New York University Langone School of Medicine, New York, NY, United States
• maromi nei, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United StatesFollow
• Catherine Scott, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
• Luke Allen, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
• Brian K Gehlbach, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; University of Iowa Carver College of Medicine, Iowa City, IA, United States
• Victoria Reick-Mitrisin, Case Western Reserve University, Cleveland, OH, United States
• Stephan Schuele, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
• Jennifer Ogren, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
• Ronald M Harper, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
• Beate Diehl, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
• Lisa M Bateman, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
• Orrin Devinsky, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; New York University Langone School of Medicine, New York, NY, United States
• George B Richerson, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; University of Iowa Carver College of Medicine, Iowa City, IA, United States
• Guo-Qiang Zhang, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
• Samden D Lhatoo, National Institute of Neurological Disorders and Stroke Center for Sudden Unexpected Death in Epilepsy Research (CSR), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States; Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States

Document Type

Article

Publication Date

2-12-2021

Comments

This article, which was first published by Frontiers Media, is the author's final published version in Frontiers in Neurology, Volume 12, February 2021, Article number 643916.

The published version is available at https://doi.org/10.3389/fneur.2021.643916.

Copyright © 2021 Ochoa-Urrea, Lacuey, Vilella, Zhu, Jamal-Omidi, Rani, Hampson, Dayyani, Hampson, Hupp, Tao, Sainju, Friedman, Nei, Scott, Allen, Gehlbach, Reick-Mitrisin, Schuele, Ogren, Harper, Diehl, Bateman, Devinsky, Richerson, Zhang and Lhatoo

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Abstract

Rationale: Seizure clusters may be related to Sudden Unexpected Death in Epilepsy (SUDEP). Two or more generalized convulsive seizures (GCS) were captured during video electroencephalography in 7/11 (64%) patients with monitored SUDEP in the MORTEMUS study. It follows that seizure clusters may be associated with epilepsy severity and possibly with SUDEP risk. We aimed to determine if electroclinical seizure features worsen from seizure to seizure within a cluster and possible associations between GCS clusters, markers of seizure severity, and SUDEP risk. Methods: Patients were consecutive, prospectively consented participants with drug-resistant epilepsy from a multi-center study. Seizure clusters were defined as two or more GCS in a 24-h period during the recording of prolonged video-electroencephalography in the Epilepsy monitoring unit (EMU). We measured heart rate variability (HRV), pulse oximetry, plethysmography, postictal generalized electroencephalographic suppression (PGES), and electroencephalography (EEG) recovery duration. A linear mixed effects model was used to study the difference between the first and subsequent seizures, with a level of significance set at p < 0.05. Results: We identified 112 GCS clusters in 105 patients with 285 seizures. GCS lasted on average 48.7 ± 19 s (mean 49, range 2–137). PGES emerged in 184 (64.6%) seizures and postconvulsive central apnea (PCCA) was present in 38 (13.3%) seizures. Changes in seizure features from seizure to seizure such as seizure and convulsive phase durations appeared random. In grouped analysis, some seizure features underwent significant deterioration, whereas others improved. Clonic phase and postconvulsive central apnea (PCCA) were significantly shorter in the fourth seizure compared to the first. By contrast, duration of decerebrate posturing and ictal central apnea were longer. Four SUDEP cases in the cluster cohort were reported on follow-up. Conclusion: Seizure clusters show variable changes from seizure to seizure. Although clusters may reflect epilepsy severity, they alone may be unrelated to SUDEP risk. We suggest a stochastic nature to SUDEP occurrence, where seizure clusters may be more likely to contribute to SUDEP if an underlying progressive tendency toward SUDEP has matured toward a critical SUDEP threshold.

Recommended Citation

Ochoa-Urrea, Manuela; Lacuey, Nuria; Vilella, Laura; Zhu, Liang; Jamal-Omidi, Shirin; Rani, M R Sandhya; Hampson, Johnson P; Dayyani, Mojtaba; Hampson, Jaison; Hupp, Norma J; Tao, Shiqiang; Sainju, Rup K; Friedman, Daniel; nei, maromi; Scott, Catherine; Allen, Luke; Gehlbach, Brian K; Reick-Mitrisin, Victoria; Schuele, Stephan; Ogren, Jennifer; Harper, Ronald M; Diehl, Beate; Bateman, Lisa M; Devinsky, Orrin; Richerson, George B; Zhang, Guo-Qiang; and Lhatoo, Samden D, "Seizure Clusters, Seizure Severity Markers, and SUDEP Risk." (2021). Department of Neurology Faculty Papers. Paper 241.
https://jdc.jefferson.edu/neurologyfp/241

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

33643216

Language

English