Abstract Details

Title Stertorous Respiratory Pattern is Associated with Symmetric and Asymmetric Tonic-Clonic Seizures, Postictal Generalized EEG Suppression and Postictal Encephalopathy.

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S3 - Epilepsy/Clinical Neurophysiology (EEG) I (1:44 PM-1:55 PM)

Poster/Presentation
Number 005

Background TC seizures are often followed by PGES, immobility and respiratory derangements which may contribute to risks for sudden unexpected death in epilepsy (SUDEP). It is unclear whether respiratory stertor is a specific sign occurring during PGES periods following bilateral symmetric TC seizures or may occur with other seizure types and postictal encephalopathy.

Objective To determine whether the obstructed respiratory pattern—stertor—is associated with symmetric and asymmetric tonic-clonic (TC) seizure types, postictal generalized EEG suppression (PGES) and postictal encephalopathy.

Design/Methods We conducted a retrospective video-EEG analysis of bilateral symmetric TC, asymmetric TC, and focal unaware seizures in consecutive patients in an EMU. The presence of stertorous respirations, motor dysfunction and encephalopathy was defined with video-audio channels; EEG slowing and PGES were evaluated by readers blinded to other findings.

Results 80 seizures were included. Bilateral symmetric TC seizures (N=35) were strongly associated with PGES (97%, p<0.001) and stertorous respirations (89%, p<0.001). None of the 25 patients with focal unaware seizures had PGES or respiratory stertor. Only 10% of 20 patients with asymmetric TC seizures had brief PGES. Asymmetric and symmetric TC seizures, however, were often (24%) associated with severe postictal encephalopathy, with stertorous respirations and decreased mobility extending beyond periods of PGES. The duration of TC seizures associated with PGES and respiratory stertor was 76 seconds (lower limit 95% CI), while the end of the postictal phase from seizure onset was 119 seconds (lower limit 95% CI).

Conclusions Most bilateral symmetric TC seizures are associated with PGES, immobility and respiratory stertor. Many patients with asymmetric and symmetric TC seizures, however, have long periods of severe post-ictal encephalopathy with stertor and impaired mobility and may be at risk for respiratory complications. Seizure detection/alerting should optimally occur within one minute of TC seizure onset; with interventions provided within 2 minutes or during periods of postictal encephalopathy.

Authors/Disclosures
Erie Gonzalez Gutierrez, MD (Medical College of Wisconsin) PRESENTER	Dr. Gonzalez Gutierrez has nothing to disclose.
Yaretson I. Carmenate	No disclosure on file
	No disclosure on file
Gregory Krauss, MD (Johns Hopkins University)	Dr. Krauss has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Arvelle. Dr. Krauss has received stock or an ownership interest from EpiWatch.

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