Abstract Details

Title Generalized Tonic Clonic Seizures Are Associated with Cerebral Tissue Hypoxemia

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S08 - (-)

Poster/Presentation
Number 007

Objective

Background It has been hypothesized that peri-ictal hypoxemia may contribute to SUDEP. Digital pulse oximetry does not directly measure oxygenation of cerebral tissues. The use of cerebral tissue oximetry in patients experiencing seizures has not been previously explored.

Design/Methods Patients with histories of generalized tonic-clonic seizures (GTCS) were prospectively recruited. All subjects were evaluated with continuous 30-channel scalp EEG and transcutaneous regional cerebral oxygen saturation (rSO2) sensors placed on each side of the forehead. Data from the rSO2 sensors were recorded every 4 seconds by a Nonin Equanox Model 7600 Regional Oximeter (Nonin, Plymouth, MN, U.S.A.). Minimum rSO2 values in the 5 minutes preceding EEG seizure onset, during the seizure, and in the 5 minutes following EEG seizure offset were recorded. SUDEP risk was assessed by using the SUDEP-7 Inventory.

Results Six patients underwent rSO2 monitoring. Ten seizures were recorded. Of the 9 seizures with useable rSO2 measurements, 6 were GTCS. GTCS were associated with significantly lower minimum ictal (54.2+/-12.8% versus 70.83+/-8.3%, Paired-Samples T-Test p=0.003) and post-ictal %rSO2 values (50.8+/-14.5% versus 70.8+/-8.3%, Paired-Samples T-Test p=0.004) than the minimum pre-ictal measurements. There was a trend towards higher SUDEP-7 Inventory scores in patients with at least one seizure with a profound %rSO2 decrease (mean SUDEP-7 Inventory score 7+/-2.8) versus patients without a seizure with a profound %rSO2 decrease (4.3+/-0.5, Mann-Whitney U Test p=0.08).

Conclusions Cerebral oximetry is feasible in monitored patients with seizures, including GTCS. Significant peri-ictal decreases in cerebral tissue oxygenation are observed with GTCS. Larger studies are needed to determine the value of cerebral oximetry in the identification of patients at risk of SUDEP.

Authors/Disclosures
Brian D. Moseley, MD PRESENTER	Dr. Moseley has received personal compensation for serving as an employee of UCB. Dr. Moseley has received personal compensation for serving as an employee of Neurocrine Biosciences Inc. Dr. Moseley has stock in UCB. Dr. Moseley has stock in Neurocrine Biosciences.
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
	No disclosure on file
Brian E. McGeeney, MD (Boston University)	No disclosure on file
Ricky Lee, MD	No disclosure on file
Elson L. So, MD, FAAN (Mayo Clinic)	Dr. So has nothing to disclose.

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