Incidence and Types of Cardiac Arrhythmias in the Peri-Ictal Period in Patients Having a Generalized Convulsive Seizure.

BACKGROUND AND OBJECTIVES: Generalized convulsive seizures (GCSs) are the main risk factor of sudden unexpected death in epilepsy (SUDEP), which is likely due to peri-ictal cardiorespiratory dysfunction. The incidence of GCS-induced cardiac arrhythmias, their relationship to seizure severity markers, and their role in SUDEP physiopathology are unknown. The aim of this study was to analyze the incidence of seizure-induced cardiac arrhythmias, their association with electroclinical features and seizure severity biomarkers, as well as their specific occurrences in SUDEP cases. METHODS: This is an observational, prospective, multicenter study of patients with epilepsy aged 18 years and older with recorded GCS during inpatient video-EEG monitoring for epilepsy evaluation. Exclusion criteria were status epilepticus and an obscured video recording. We analyzed semiologic and cardiorespiratory features through video-EEG (VEEG), electrocardiogram, thoracoabdominal bands, and pulse oximetry. We investigated the presence of bradycardia, asystole, supraventricular tachyarrhythmias (SVTs), premature atrial beats, premature ventricular beats, nonsustained ventricular tachycardia (NSVT), atrial fibrillation (Afib), ventricular fibrillation (VF), atrioventricular block (AVB), exaggerated sinus arrhythmia (ESA), and exaggerated sinus arrhythmia with bradycardia (ESAWB). A board-certified cardiac electrophysiologist diagnosed and classified the arrhythmia types. Bradycardia, asystole, SVT, NSVT, Afib, VF, AVB, and ESAWB were classified as arrhythmias of interest because these were of SUDEP pathophysiology value. The main outcome was the occurrence of seizure-induced arrhythmias of interest during inpatient VEEG monitoring. Moreover, yearly follow-up was conducted to identify SUDEP cases. Binary logistic generalized estimating equations were used to determine clinical-demographic and peri-ictal variables that were predictive of the presence of seizure-induced arrhythmias of interest. The z-score test for 2 population proportions was used to test whether the proportion of seizures and patients with postconvulsive ESAWB or bradycardia differed between SUDEP cases and survivors. RESULTS: This study includes data from 249 patients (mean age 37.2 ± 23.5 years, 55% female) who had 455 seizures. The most common arrhythmia was ESA, with an incidence of 137 of 382 seizures (35.9%) (106/224 patients [47.3%]). There were 50 of 352 seizure-induced arrhythmias of interest (14.2%) in 41 of 204 patients (20.1%). ESAWB was the commonest in 22 of 394 seizures (5.6%) (18/225 patients [8%]), followed by SVT in 18 of 397 seizures (4.5%) (17/228 patients [7.5%]). During follow-up (48.36 ± 31.34 months), 8 SUDEPs occurred. Seizure-induced bradycardia (3.8% vs 12.5%, z = -16.66, p < 0.01) and ESAWB (6.6% vs 25%; z = -3.03, p < 0.01) were over-represented in patients who later died of SUDEP. There was no association between arrhythmias of interest and seizure severity biomarkers (p > 0.05). DISCUSSION: Markers of seizure severity are not related to seizure-induced arrhythmias of interest, suggesting that other factors such as occult cardiac abnormalities may be relevant for their occurrence. Seizure-induced ESAWB and bradycardia were more frequent in SUDEP cases, although this observation was based on a very limited number of SUDEP patients. Further case-control studies are needed to evaluate the yield of arrhythmias of interest along with respiratory changes as potential SUDEP biomarkers.

Seizure Analysis Presented to Emergency Department in Saudi Arabia: New VS Chronic Cases.

Background: Epilepsy, characterized by recurrent unprovoked seizures, poses a significant global burden on individuals and healthcare systems. Accurate identification of underlying causes is vital for optimal intervention. However, studies reveal a lack of standardized approaches, potentially resulting in unnecessary investigations. Objective: We aimed to highlight the importance of avoiding unnecessary testing to minimize healthcare costs and resource waste. Methods: In the Emergency Department of King Fahd Hospital of the University (KFUH) in Alkhobar, a retrospective cross-sectional study encompassed 190 patients presenting with seizures from January 1, 2020, to December 31, 2022. The study aimed to elucidate the epidemiological profile and distinguish clinical and demographic factors between new onset seizures and known cases. Results: The study included 190 epilepsy cases, with 51.1% known and 48.9% new onset. Generalized tonic-clonic seizures were prominent (43.2%), and non-compliance (24.2%) was a leading cause. New onset seizures were associated with abnormal CT findings (p=0.025), drug use (74.2%), and intoxication (6.5%). Demographically, Saudis showed higher new onset prevalence (82.8%, p=0.001). Conclusion: The average length of stay was 5.93 hours, and the distribution of new vs. known cases was nearly equal among the 190 patients. Laboratory findings showed no significant associations with either group, mostly falling within the normal range. To optimize care further, we recommend continued refinement of protocols, emphasis on medication compliance.

Estimulación crónica intermitente del nervio vago en el tratamiento de epilepsia refractaria: experiencia en México con 35 casos / Chronic intermittent vagal nerve stimulation in the treatment of refractory epilepsy: experience in Mexico with 35 cases

Introducción: El papel de la estimulación crónica intermitente del nervio vago (ECINV) en el tratamiento de la epilepsia refractaria está evolucionando y requiere precisarse mediante la descripción de resultados, efectos adversos y complicaciones en poblaciones específicas. Material y métodos: Se seleccionaron los pacientes con epilepsia refractaria sometidos a ECINV con mínimo 12 meses de seguimiento, utilizando estadística descriptiva e inferencial para valorar el efecto sobre la frecuencia e intensidad de las crisis, memoria, ánimo, estado de alerta, recuperación postictal y calidad de vida (escala subjetiva, cuestionario QoLIE-31), y los factores (sexo, edad, tiempo de evolución, número/tipo crisis, parámetros de estimulación) asociados a la respuesta clínica. Se describen los parámetros de estimulación usados, empleo del magneto, complicaciones y efectos adversos. Resultados: Se seleccionaron 35 pacientes, edad de cinco a 48 años, 18 con epilepsia parcial, 17 con generalizada. No hubo complicaciones, infección o alteración de la cicatrización en los procedimientos quirúrgicos. La reducción promedio en crisis fue de 55.65 % (p < 0.001). En epilepsias generalizadas hubo 58.8 % de respondedores y 88.9 % en parciales. Cuatro sujetos presentaron mejoría > 90 %, con control total; en dos pacientes aumentó la frecuencia de las crisis. La respuesta al tratamiento fue buena subjetivamente en 33 pacientes. La calificación global de QoLIE-31 aumentó 12.6 puntos (p = 0.020). Solo el tipo de crisis se asoció con la respuesta clínica. Los efectos adversos fueron transitorios y respondieron al cambio de parámetros de estimulación. Conclusiones: la ECINV es segura, bien tolerada y eficaz para el tratamiento paliativo en casos seleccionados de crisis parciales y generalizadas multifocales refractarias.

BACKGROUND: The role of vagal nerve stimulation (VNS) in the treatment of refractory epilepsy is still evolving and requires precision through extensive description of acute and chronic results, adverse effects and complications in specific populations. METHODS: We selected patients with refractory epilepsy subjected to VNS who had completed at least a 12-month followup. Descriptive and inferential statistics were used to review and assess the effects of VNS on seizure frequency/intensity, memory, alertness, mood, postictal recovery, and quality of life (subjective scale, QoL IE-31 inventory) as well as factors (gender, age, age of onset, time of surgery, stimulation parameters, seizure frequency and type) associated with clinical response. We describe stimulation parameters, complications and adverse effects compared to other series. RESULTS: We selected 35 patients with an age range of 5-48 years; 18 patients presented partial epilepsy and 17 generalized epilepsy. All procedures and wound healing were uneventful, and no infections were reported. Median reduction in seizure frequency was 55.65% (p <0.001). Four patients showed improvement of >90%. Two patients became seizure free, whereas seizure frequency increased in two patients. The subjectively qualified response to treatment was good in 33 patients. The mean global increase in the QoLIE-31 Scale was 12.6 (p = 0.020). Improvements in memory, mood, alertness and postictal recovery period were documented. Only seizure type showed statistically significant association with clinical response. Adverse effects were transitory and responded to changes in stimulation parameters. CONCLUSIONS: VNS is a safe, feasible, well-tolerated and effective palliative treatment in appropriately selected cases of refractory partial and multifocal generalized seizures.