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Epilepsia. 2017 Jun;58(6):e87-e90. doi: 10.1111/epi.13765. Epub 2017 May 2.

Obstructive apnea due to laryngospasm links ictal to postictal events in SUDEP cases and offers practical biomarkers for review of past cases and prevention of new ones.

Author information

1
Department of Neurology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A.
2
Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A.
3
Department of Cell Biology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A.
4
Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A.
5
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A.

Abstract

Seizure spread into autonomic and respiratory brainstem regions is thought to play an important role in sudden unexpected death in epilepsy (SUDEP). As the clinical dataset of cases of definite SUDEP available for study grows, evidence points to a sequence of events that includes postictal apnea, bradycardia, and asystole as critical events that can lead to death. One possible link between the precipitating seizure and the critical postictal sequence is seizure-driven laryngospasm sufficient to completely obstruct the airway for an extended period, but ictal laryngospasm is difficult to fully assess. Herein, we demonstrate in a rat model how the electrical artifacts of attempts to inspire during airway obstruction and features of the cardiac rhythm establish this link between ictal and postictal activity and can be used as practical biomarkers of obstructive apnea due to laryngospasm or other causes of airway obstruction.

KEYWORDS:

Apnea; Laryngospasm; SUDEP; Sudden death

PMID:
28464295
DOI:
10.1111/epi.13765
[Indexed for MEDLINE]
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