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Neurology. 2015 Nov 3;85(18):1598-603. doi: 10.1212/WNL.0000000000001949. Epub 2015 Sep 2.

Risk factors of postictal generalized EEG suppression in generalized convulsive seizures.

Author information

1
From the Department of Functional Neurology and Epileptology (V.A., B.M., S.R.) and the Institute of Epilepsies (E.H., P.R., S.R.), Hospices Civils de Lyon and Lyon 1 University; Lyon's Neuroscience Research Center (V.A., B.M., P.R., S.R.), INSERM U1028/CNRS UMR 5292, Lyon, France; the Hospital of Clinics of Ribeirão Preto (V.A.), University of São Paulo, Brazil; the Department of Neurology (L.V., M.D.), University Hospital of Toulouse; the Neurology Department (L.M., J.J.), University Hospital of Nancy; the Clinical Neurophysiology and Epileptology Department (F.B.), Timone Hospital, Marseille; the Department of Clinical Neurophysiology (W.S.), Lille University Medical Center, EA 1046, University of Lille2; the Department of Neurology (E.H.), University Hospital of Strasbourg; the Department of Neurology (C.M.), Hôpital Pellegrin, Bordeaux; the Epilepsy Unit (F.C.), Department of Neurosurgery, Centre Hospitalier Sainte-Anne; University Paris Descartes; La Teppe Epilepsy Center (J.P.), Tain l'Hermitage; the Epilepsy Unit (A.C.), Montpellier; the Department of Neurology (A.N.), University Hospital of Rennes; the Epileptology Unit (V.N.), Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière and Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC University Paris 06), Paris; the Department of Neurology (P.K.), Michallon Hospital, GIN, INSERM U836, UJF, Grenoble Alpes University, Grenoble; the Department of Clinical Neurophysiology (B.D.T.), INSERM U930, University Hospital of Tours; the Department of Neurology (P.T.), University Hospital of Nice; the Department of Neurology (S.R.), University Hospital of Clermont-Ferrand, France; and the Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland.
2
From the Department of Functional Neurology and Epileptology (V.A., B.M., S.R.) and the Institute of Epilepsies (E.H., P.R., S.R.), Hospices Civils de Lyon and Lyon 1 University; Lyon's Neuroscience Research Center (V.A., B.M., P.R., S.R.), INSERM U1028/CNRS UMR 5292, Lyon, France; the Hospital of Clinics of Ribeirão Preto (V.A.), University of São Paulo, Brazil; the Department of Neurology (L.V., M.D.), University Hospital of Toulouse; the Neurology Department (L.M., J.J.), University Hospital of Nancy; the Clinical Neurophysiology and Epileptology Department (F.B.), Timone Hospital, Marseille; the Department of Clinical Neurophysiology (W.S.), Lille University Medical Center, EA 1046, University of Lille2; the Department of Neurology (E.H.), University Hospital of Strasbourg; the Department of Neurology (C.M.), Hôpital Pellegrin, Bordeaux; the Epilepsy Unit (F.C.), Department of Neurosurgery, Centre Hospitalier Sainte-Anne; University Paris Descartes; La Teppe Epilepsy Center (J.P.), Tain l'Hermitage; the Epilepsy Unit (A.C.), Montpellier; the Department of Neurology (A.N.), University Hospital of Rennes; the Epileptology Unit (V.N.), Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière and Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC University Paris 06), Paris; the Department of Neurology (P.K.), Michallon Hospital, GIN, INSERM U836, UJF, Grenoble Alpes University, Grenoble; the Department of Clinical Neurophysiology (B.D.T.), INSERM U930, University Hospital of Tours; the Department of Neurology (P.T.), University Hospital of Nice; the Department of Neurology (S.R.), University Hospital of Clermont-Ferrand, France; and the Department of Clinical Neurosciences (P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland. sylvain.rheims@univ-lyon1.fr.

Abstract

OBJECTIVE:

To identify the clinical determinants of occurrence of postictal generalized EEG suppression (PGES) after generalized convulsive seizures (GCS).

METHODS:

We reviewed the video-EEG recordings of 417 patients included in the REPO2MSE study, a multicenter prospective cohort study of patients with drug-resistant focal epilepsy. According to ictal semiology, we classified GCS into 3 types: tonic-clonic GCS with bilateral and symmetric tonic arm extension (type 1), clonic GCS without tonic arm extension or flexion (type 2), and GCS with unilateral or asymmetric tonic arm extension or flexion (type 3). Association between PGES and person-specific or seizure-specific variables was analyzed after correction for individual effects and the varying number of seizures.

RESULTS:

A total of 99 GCS in 69 patients were included. Occurrence of PGES was independently associated with GCS type (p < 0.001) and lack of early administration of oxygen (p < 0.001). Odds ratio (OR) for GCS type 1 in comparison with GCS type 2 was 66.0 (95% confidence interval [CI 5.4-801.6]). In GCS type 1, risk of PGES was significantly increased when the seizure occurred during sleep (OR 5.0, 95% CI 1.2-20.9) and when oxygen was not administered early (OR 13.4, 95% CI 3.2-55.9).

CONCLUSION:

The risk of PGES dramatically varied as a function of GCS semiologic characteristics. Whatever the type of GCS, occurrence of PGES was prevented by early administration of oxygen.

PMID:
26333799
DOI:
10.1212/WNL.0000000000001949
[Indexed for MEDLINE]

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