Association between postictal EEG suppression, postictal autonomic dysfunction, and sudden unexpected death in epilepsy: Evidence from intracranial EEG

Behnaz Esmaeili, Department of Neurology, University of Washington, Seattle, WA, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: Behnaz.esmaeili@gmail.com.
Daniel Weisholtz, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Steven Tobochnik, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Barbara Dworetzky, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Daniel Friedman, Department of Neurology, New York University School of Medicine, New York, NY, USA.
Farhad Kaffashi, Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA.
Sydney Cash, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Brannon Cha, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Juliana Laze, Department of Neurology, New York University School of Medicine, New York, NY, USA.
Dustine Reich, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Pue Farooque, Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Taha Gholipour, Department of Neurology, George Washington University, Washington, DC, USA.
Michael Singleton, Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA.
Kenneth Loparo, Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA.
Mohamad Koubeissi, Department of Neurology, George Washington University, Washington, DC, USA.
Orrin Devinsky, Department of Neurology, New York University School of Medicine, New York, NY, USA.
Jong Woo Lee, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.

Document Type

Journal Article

Publication Date

2-1-2023

Journal

Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology

Volume

146

DOI

10.1016/j.clinph.2022.12.002

Keywords

Heart rate variability; Intracranial EEG; Postictal EEG suppression; SUDEP; Scalp EEG; Sudden Unexpected Death in Epilepsy

Abstract

OBJECTIVE: The association between postictal electroencephalogram (EEG) suppression (PES), autonomic dysfunction, and Sudden Unexpected Death in Epilepsy (SUDEP) remains poorly understood. We compared PES on simultaneous intracranial and scalp-EEG and evaluated the association of PES with postictal heart rate variability (HRV) and SUDEP outcome. METHODS: Convulsive seizures were analyzed in patients with drug-resistant epilepsy at 5 centers. Intracranial PES was quantified using the Hilbert transform. HRV was quantified using root mean square of successive differences of interbeat intervals, low-frequency to high-frequency power ratio, and RR-intervals. RESULTS: There were 64 seizures from 63 patients without SUDEP and 11 seizures from 6 SUDEP patients. PES occurred in 99% and 87% of seizures on intracranial-EEG and scalp-EEG, respectively. Mean PES duration in intracranial and scalp-EEG was similar. Intracranial PES was regional (<90% of channels) in 46% of seizures; scalp PES was generalized in all seizures. Generalized PES showed greater decrease in postictal parasympathetic activity than regional PES. PES duration and extent were similar between patients with and without SUDEP. CONCLUSIONS: Regional intracranial PES can be present despite scalp-EEG demonstrating generalized or no PES. Postictal autonomic dysfunction correlates with the extent of PES. SIGNIFICANCE: Intracranial-EEG demonstrates changes in autonomic regulatory networks not seen on scalp-EEG.

Department

Neurology

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