Hypoxemia following generalized convulsive seizures: Risk factors and effect of oxygen therapy.

Neurology

From the Department of Functional Neurology and Epileptology (S.R., B.M.A., V.A.), Hospices Civils de Lyon and University of Lyon; Lyon's Neuroscience Research Center (S.R., B.M.A., V.A., L.B., P.R.), INSERM U1028/CNRS UMR 5292, France; Hospital of Clinics of Ribeirão Preto (V.A.), University of São Paulo, Brazil; Department of Neurology (J.C., L.V.), University Hospital of Toulouse; Neurology Department (L.M.), University Hospital of Nancy; Clinical Neurophysiology and Epileptology Department (F.B.), Timone Hospital, Marseille; Department of Clinical Neurophysiology (P.D.), Lille University Medical Center, EA 1046, University of Lille2; Department of Neurology (E.H.), University Hospital of Strasbourg; Department of Neurology (V.M.), Hôpital Pellegrin, Bordeaux; Epilepsy Unit, Department of Neurosurgery (F.C.), Centre Hospitalier Sainte-Anne, University Paris Descartes; La Teppe Epilepsy Center (D.T.), Tain l'Hermitage,; Epilepsy Unit (A.C.), Montpellier; Department of Neurology (A.B.), University Hospital of Rennes; Epileptology Unit (V.N.), Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière and Brain and Spine Institute (ICM; INSERM UMRS1127, CNRS UMR7225, UPMC University Paris 06); Department of Neurology (P.K.), Grenoble-Alpes University Hospital, GIN, INSERM U1216, and Grenoble Alpes University; Department of Clinical Neurophysiology (B.D.T.), INSERM U930, University Hospital of Tours; Department of Neurology (P.T.), University Hospital of Nice; Department of Neurology (S.R.), University Hospital of Clermont-Ferrand, France; Department of Clinical Neurosciences (S.R., P.R.), Centre Hospitalo-Universitaire Vaudois, Lausanne, Switzerland; and Epilepsy Institute (E.H., L.B., P.R.), Lyon, France.

Published: January 2019

Objective: To analyze the factors that determine the occurrence or severity of postictal hypoxemia in the immediate aftermath of a generalized convulsive seizure (GCS).

Methods: We reviewed the video-EEG recordings of 1,006 patients with drug-resistant focal epilepsy included in the REPOMSE study to identify those with ≥1 GCS and pulse oximetry (SpO) measurement. Factors determining recovery of SpO ≥ 90% were investigated using Cox proportional hazards models. Association between SpO nadir and person- or seizure-specific variables was analyzed after correction for individual effects and the varying number of seizures.

Results: A total of 107 GCS in 73 patients were analyzed. A transient hypoxemia was observed in 92 GCS (86%). Rate of GCS with SpO <70% dropped from 40% to 21% when oxygen was administered early ( = 0.046). Early recovery of SpO ≥90% was associated with early administration of oxygen ( = 0.004), absence of postictal generalized EEG suppression (PGES) ( = 0.014), and extratemporal lobe epilepsy ( = 0.001). Lack of early administration of O ( = 0.003), occurrence of PGES ( = 0.018), and occurrence of ictal hypoxemia during the focal phase ( = 0.022) were associated with lower SpO nadir.

Conclusion: Postictal hypoxemia was observed in the immediate aftermath of nearly all GCS but administration of oxygen had a strong preventive effect. Severity of postictal hypoxemia was greater in temporal lobe epilepsy and when hypoxemia was already observed before the onset of secondary GCS.

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Source
http://dx.doi.org/10.1212/WNL.0000000000006777DOI Listing

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