Seizure‐related apneas have an inconsistent linkage to amygdala seizure spread

Objective Sudden unexpected death in epilepsy (SUDEP) is a frequent cause of death in epilepsy. Respiratory dysfunction is implicated as a critical factor in SUDEP pathophysiology. Human studies have shown that electrical stimulation of the amygdala resulted in apnea, indicating that the amygdala ha...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2020-06, Vol.61 (6), p.1253-1260
Main Authors: Park, Katherine, Kanth, Kiran, Bajwa, Sami, Girgis, Fady, Shahlaie, Kiarash, Seyal, Masud
Format: Article
Language:English
Subjects:
Amygdala
Apnea
Brain stem
Convulsions & seizures
Electrical stimuli
Epilepsy
Pathophysiology
Respiration
seizure
Seizures
SUDEP
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Summary:Objective Sudden unexpected death in epilepsy (SUDEP) is a frequent cause of death in epilepsy. Respiratory dysfunction is implicated as a critical factor in SUDEP pathophysiology. Human studies have shown that electrical stimulation of the amygdala resulted in apnea, indicating that the amygdala has a role in respiration control. Unilateral amygdala stimulation resulted in immediate onset of respiratory dysfunction occurring only during nose breathing. In small numbers of patients, some but not all spontaneous seizures resulted in apnea occurring shortly after seizure spread to the amygdala. With this study we aimed to determine whether seizure onset or spread to the amygdala was necessary and sufficient to cause apnea. Methods We investigated the temporal relationship between apnea/hypopnea (AH) onset and initial seizure involvement within the amygdala in patients with implanted depth electrodes. Results Data from 17 patients (11 female) with 47 seizures were analyzed. With seven seizures (three patients), AH preceded amygdala seizure involvement by 2 to 55 seconds. There was no AH with four seizures (three patients) that involved the amygdala. With eight seizures (four patients) AH occurred within 2 seconds following amygdala seizure onset. With 28 seizures, AH started >2 seconds after amygdala seizure onset (range 3‐158 seconds). Following seizure onset, there was a significant difference between AH onset time and amygdala seizure onset (P 
ISSN:0013-9580
1528-1167
DOI:10.1111/epi.16518