Association of Peri-ictal Brainstem Posturing With Seizure Severity and Breathing Compromise in Patients With Generalized Convulsive Seizures

作者：Laura Vilella, Nuria Lacuey, Johnson P. Hampson, Liang Zhu, Shirin Jamal Omidi, Manuela Ochoa‐Urrea, Shiqiang Tao, M.R. Sandhya Rani, Rup K. Sainju, Daniel Friedman, Maromi Nei, Kingman P. Strohl, Catherine Scott, Luke A. Allen, Brian K. Gehlbach, Norma J. Hupp, Jaison S. Hampson, Nassim Shafiabadi, Xiuhe Zhao, Victoria Reick-Mitrisin, Stephan Schuele, Jennifer A. Ogren, Ronald M. Harper, Beate Diehl, Lisa M. Bateman, Orrin Devinsky, George B. Richerson, Philippe Ryvlin, Guo‐Qiang Zhang, Samden Lhatoo · 发表于：Neurology · 年份：2020 · DOI：10.1212/wnl.0000000000011274 · 被引用次数：34 · 研究领域：Epilepsy research and treatment、Psychosomatic Disorders and Their Treatments、Cardiovascular Syncope and Autonomic Disorders

Objective To analyze the association between peri-ictal brainstem posturing semiologies with postictal generalized electroencephalographic suppression (PGES) and breathing dysfunction in generalized convulsive seizures (GCS). Methods 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. Results 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, p < 0.001), decortication (OR 11.26, 95% CI 2.96–42.93, p < 0.001), or hemi-decerebration (OR 48.56, 95% CI 6.07–388.78, p < 0.001). Ictal decerebration was associated with longer PGES ( p = 0.011). Postictal posturing was associated with postconvulsive central apnea (PCCA) ( p = 0.004), longer hypoxemia ( p < 0.001), and Spo 2 recovery ...