Association of Peri-ictal Brainstem Posturing With Seizure Severity and Breathing Compromise in Patients With Generalized Convulsive Seizures.
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
19 01 2021
19 01 2021
Historique:
received:
18
08
2019
accepted:
17
08
2020
pubmed:
4
12
2020
medline:
2
2
2021
entrez:
3
12
2020
Statut:
ppublish
Résumé
To analyze the association between peri-ictal brainstem posturing semiologies with postictal generalized electroencephalographic suppression (PGES) and breathing dysfunction in generalized convulsive seizures (GCS). In this prospective, multicenter analysis of GCS, ictal brainstem semiology was classified as (1) decerebration (bilateral symmetric tonic arm extension), (2) decortication (bilateral symmetric tonic arm flexion only), (3) hemi-decerebration (unilateral tonic arm extension with contralateral flexion) and (4) absence of ictal tonic phase. Postictal posturing was also assessed. Respiration was monitored with thoracoabdominal belts, video, and pulse oximetry. Two hundred ninety-five seizures (180 patients) were analyzed. Ictal decerebration was observed in 122 of 295 (41.4%), decortication in 47 of 295 (15.9%), and hemi-decerebration in 28 of 295 (9.5%) seizures. Tonic phase was absent in 98 of 295 (33.2%) seizures. Postictal posturing occurred in 18 of 295 (6.1%) seizures. PGES risk increased with ictal decerebration (odds ratio [OR] 14.79, 95% confidence interval [CI] 6.18-35.39, Ictal brainstem semiology is associated with increased PGES risk. Ictal decerebration is associated with longer PGES. Postictal posturing is associated with a 6-fold increased risk of PCCA, longer hypoxemia, and Spo This study provides Class III evidence that peri-ictal brainstem posturing is associated with the GCS with more prolonged PGES and more severe breathing dysfunction.
Identifiants
pubmed: 33268557
pii: WNL.0000000000011274
doi: 10.1212/WNL.0000000000011274
pmc: PMC7884980
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e352-e365Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR003167
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS090407
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS113764
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS090405
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS090414
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 American Academy of Neurology.
Références
Epilepsia. 2019 Jun;60(6):1221-1233
pubmed: 31056750
Epilepsia. 2017 Dec;58(12):2164-2171
pubmed: 29105057
Neurology. 2019 Jan 15;92(3):e183-e193
pubmed: 30568004
Brain. 2018 Jun 1;141(6):1719-1733
pubmed: 29608654
Epilepsia. 2019 Feb;60(2):201-210
pubmed: 30645779
Epilepsia. 2013 May;54(5):858-65
pubmed: 23360300
Epilepsia. 2017 Apr;58(4):512-521
pubmed: 28276062
Brain. 2015 Oct;138(Pt 10):2907-19
pubmed: 26264515
Neurology. 2012 Jan 17;78(3):210-7
pubmed: 22249496
Neuroscience. 1998 May;84(2):619-25
pubmed: 9539230
J Physiol. 2013 Jan 1;591(1):109-22
pubmed: 23129795
Epilepsia. 2016 Mar;57(3):412-7
pubmed: 26763069
Neurology. 2017 Jul 11;89(2):170-177
pubmed: 28592455
Epilepsia. 2017 Aug;58(8):1409-1414
pubmed: 28555759
Epilepsia. 2011 Jun;52(6):1150-9
pubmed: 21671925
Brain. 2019 Feb 1;142(2):412-425
pubmed: 30649209
Ann N Y Acad Sci. 1998 Nov 16;860:566-9
pubmed: 9928365
Epilepsia. 2019 Jan;60(1):74-84
pubmed: 30577077
Lancet. 1974 Jul 13;2(7872):81-4
pubmed: 4136544
Epilepsia. 2017 Sep;58(9):1637-1644
pubmed: 28691204
Arch Neurol. 1971 Dec;25(6):517-25
pubmed: 5115553
N Engl J Med. 1968 Apr 18;278(16):876-9
pubmed: 5300361
Neurology. 2019 Jan 15;92(3):e171-e182
pubmed: 30568003
Epilepsia. 2017 Apr;58(4):522-530
pubmed: 28276060
Neurology. 2019 Feb 12;92(7):e655-e669
pubmed: 30635481
Lancet Neurol. 2008 Nov;7(11):1021-31
pubmed: 18805738
Epilepsia. 2019 Jan;60(1):63-73
pubmed: 30565663
Front Neurol. 2019 Mar 01;10:166
pubmed: 30890997
Behav Brain Res. 1993 Dec 20;58(1-2):27-47
pubmed: 8136048
Lancet Neurol. 2013 Oct;12(10):966-77
pubmed: 24012372
J Physiol. 1898 Feb 17;22(4):319-32
pubmed: 16992412
Ann Neurol. 2010 Dec;68(6):787-96
pubmed: 20882604
Pediatr Neurol. 2017 Nov;76:54-59
pubmed: 28967460
Neurology. 2015 Nov 3;85(18):1598-603
pubmed: 26333799
Epilepsia. 2012 May;53(5):825-31
pubmed: 22432911
J Neurosci. 2008 Nov 19;28(47):12274-83
pubmed: 19020021
Am J Med. 1985 Jun;78(6 Pt 1):1036-7
pubmed: 4014263
Epilepsia. 2018 Mar;59(3):573-582
pubmed: 29336036
Epilepsy Res. 2018 Nov;147:1-8
pubmed: 30165263
Epilepsy Res. 2017 Sep;135:87-94
pubmed: 28646692
Epilepsia. 2010 Jun;51(6):1069-77
pubmed: 19889013
J Neurol Neurosurg Psychiatry. 2016 Apr;87(4):402-13
pubmed: 26979537
IEEE Trans Biomed Eng. 2018 Feb;65(2):371-377
pubmed: 29346105
Sci Transl Med. 2015 Apr 8;7(282):282ra46
pubmed: 25855492
Arch Neurol. 1971 Dec;25(6):501-16
pubmed: 5000501