Postictal clinical and electroencephalographic activity following intracranially recorded bilateral tonic-clonic seizures.


Journal

Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R

Informations de publication

Date de publication:
01 2019
Historique:
received: 28 09 2018
revised: 19 11 2018
accepted: 20 11 2018
pubmed: 24 12 2018
medline: 10 4 2020
entrez: 22 12 2018
Statut: ppublish

Résumé

The dynamics of the postictal period, which may demonstrate such dramatic clinical phenomena as focal neurological deficits, prolonged coma and immobility, and even sudden death, are poorly understood. We sought to classify and characterize postictal phases of bilateral tonic-clonic seizures based on electroencephalographic (EEG) criteria and associated clinical features. We performed a detailed electroclinical evaluation of the postictal period in a series of 31 bilateral tonic-clonic seizures in 16 patients undergoing epilepsy surgery evaluations for focal pharmacoresistant epilepsy with intracranial electrodes and time-locked video. The postictal EEG demonstrated three clearly differentiated phases as follows: attenuation, a burst-attenuation pattern, and a return to continuous background, with abrupt, synchronized transitions between phases. Postictal attenuation was common, occurring in 84% of seizures in 94% of patients in this study. There was increased power in gamma frequencies (>25 Hz) during postictal attenuation periods relative to preictal baseline in 88% of seizures demonstrating the attenuation pattern (n = 25 seizures, P < 0.002). Such increases were seen in >90% of channels in 13 seizures (52%) and <10% of channels in three seizures (12%). Postictal immobility was seen in 87% of seizures, with either a flaccid (58%) or rigid/dystonic (29%) appearance. Clinical motor manifestations, including focal dystonic posturing, automatisms, head and eye deviation, and myoclonic jerking, continued or emerged within the first minute following seizure termination in 48% of seizures, regardless of EEG appearance. Intracranial postictal attenuation, which may be diffuse or focal, is so common that it should be regarded as a ubiquitous feature of bilateral tonic-clonic seizures, rather than an unusual event. The prominence of high-frequency activity coupled with emerging clinical features, including rigid immobility and semiologies such as automatisms, during the postictal period supports the presence of ongoing seizure-related neuronal activity in unrecorded brain regions.

Identifiants

pubmed: 30577077
doi: 10.1111/epi.14621
pmc: PMC6400590
mid: NIHMS998824
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

74-84

Subventions

Organisme : NINDS NIH HHS
ID : R01 NS084142
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS095368
Pays : United States
Organisme : Citizens United for Research in Epilepsy Henry Lapham Memorial Award
Pays : International

Informations de copyright

Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.

Références

J Nerv Ment Dis. 1958 Jul;127(1):21-33
pubmed: 13564242
Prog Neurobiol. 1992 Aug;39(2):155-78
pubmed: 1502335
Epilepsia. 2005 May;46(5):669-76
pubmed: 15857432
Epilepsy Res. 2006 Aug;70(2-3):239-43
pubmed: 16765567
Epilepsia. 2007 Nov;48(11):2167-76
pubmed: 17662060
Ann Neurol. 2010 Dec;68(6):787-96
pubmed: 20882604
PLoS Biol. 2011 Apr;9(4):e1000610
pubmed: 21532743
Neurology. 2011 Aug 9;77(6):524-31
pubmed: 21753167
Epilepsia. 2012 Feb;53(2):e21-4
pubmed: 22050242
Neurology. 2013 Oct 1;81(14):1252-6
pubmed: 23966251
Lancet Neurol. 2013 Oct;12(10):966-77
pubmed: 24012372
Brain. 2013 Dec;136(Pt 12):3796-808
pubmed: 24176977
Electroencephalogr Clin Neurophysiol. 1988 Aug;70(2):99-104
pubmed: 2456198
J Neurosci. 2014 Aug 27;34(35):11733-43
pubmed: 25164668
Neuron. 2015 Feb 4;85(3):561-72
pubmed: 25654258
Sci Transl Med. 2015 Apr 8;7(282):282ra46
pubmed: 25855492
Neurology. 2015 Jun 9;84(23):2320-8
pubmed: 25972493
Neurology. 2015 Nov 3;85(18):1598-603
pubmed: 26333799
Epilepsia. 2015 Dec;56(12):e198-202
pubmed: 26530287
Seizure. 2015 Nov;32:9-15
pubmed: 26552555
Epilepsia. 2016 Mar;57(3):412-7
pubmed: 26763069
Nat Commun. 2016 Mar 29;7:11098
pubmed: 27020798
Epilepsy Behav. 2016 Sep;62:218-24
pubmed: 27494359
Epilepsia. 2017 Sep;58(9):1637-1644
pubmed: 28691204
J Neurophysiol. 2018 Jan 1;119(1):145-159
pubmed: 28954895
IEEE Trans Biomed Eng. 2018 Feb;65(2):371-377
pubmed: 29346105
Arch Neurol. 1994 Mar;51(3):254-9
pubmed: 8129636
Epilepsia. 1997 Jun;38(6):642-54
pubmed: 9186246

Auteurs

Lisa M Bateman (LM)

Department of Neurology, Columbia University Medical Center, New York, New York.

Anil Mendiratta (A)

Department of Neurology, Columbia University Medical Center, New York, New York.

Jyun-You Liou (JY)

Department of Physiology and Cellular Biophysics, Columbia University Medical Center, New York, New York.

Elliot J Smith (EJ)

Department of Neurological Surgery, Columbia University Medical Center, New York, New York.

Carl W Bazil (CW)

Department of Neurology, Columbia University Medical Center, New York, New York.

Hyunmi Choi (H)

Department of Neurology, Columbia University Medical Center, New York, New York.

Guy M McKhann (GM)

Department of Neurological Surgery, Columbia University Medical Center, New York, New York.

Alison Pack (A)

Department of Neurology, Columbia University Medical Center, New York, New York.

Shraddha Srinivasan (S)

Department of Neurology, Columbia University Medical Center, New York, New York.

Catherine A Schevon (CA)

Department of Neurology, Columbia University Medical Center, New York, New York.

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