Failure to breathe persists without air hunger or alarm following amygdala seizures.
JCI Insight
; 8(22)2023 Nov 22.
Article
em En
| MEDLINE
| ID: mdl-37788112
ABSTRACT
Postictal apnea is thought to be a major cause of sudden unexpected death in epilepsy (SUDEP). However, the mechanisms underlying postictal apnea are unknown. To understand causes of postictal apnea, we used a multimodal approach to study brain mechanisms of breathing control in 20 patients (ranging from pediatric to adult) undergoing intracranial electroencephalography for intractable epilepsy. Our results indicate that amygdala seizures can cause postictal apnea. Moreover, we identified a distinct region within the amygdala where electrical stimulation was sufficient to reproduce prolonged breathing loss persisting well beyond the end of stimulation. The persistent apnea was resistant to rising CO2 levels, and air hunger failed to occur, suggesting impaired CO2 chemosensitivity. Using es-fMRI, a potentially novel approach combining electrical stimulation with functional MRI, we found that amygdala stimulation altered blood oxygen level-dependent (BOLD) activity in the pons/medulla and ventral insula. Together, these findings suggest that seizure activity in a focal subregion of the amygdala is sufficient to suppress breathing and air hunger for prolonged periods of time in the postictal period, likely via brainstem and insula sites involved in chemosensation and interoception. They further provide insights into SUDEP, may help identify those at greatest risk, and may lead to treatments to prevent SUDEP.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Apneia
/
Morte Súbita Inesperada na Epilepsia
Tipo de estudo:
Prognostic_studies
Limite:
Adult
/
Child
/
Humans
Idioma:
En
Revista:
JCI Insight
Ano de publicação:
2023
Tipo de documento:
Article