Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration

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Abstract

Purpose Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. Method Chest X-rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression. Results Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p = 0.002) in GTCS with abnormal CXR (259.7 s) versus GTCS with normal CXR (101.2 s). Odds-ratio for CXR abnormality was 20.46 (p = 0.006) with seizure duration greater than 100 s versus less than 100 s. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p = 0.015). Conclusion Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP.

Original languageEnglish (US)
Pages (from-to)19-24
Number of pages6
JournalSeizure
Volume27
DOIs
StatePublished - Apr 1 2015

Fingerprint

Pulmonary Edema
Seizures
Thorax
X-Rays
Epilepsy
Sudden Death
Apnea
Electroencephalography
Autopsy
Logistic Models
Stroke
Odds Ratio
Oxygen

Keywords

  • Convulsion
  • Pulmonary edema
  • Seizure
  • SUDEP

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

@article{6825618af9384f218126e1491a8d9741,
title = "Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration",
abstract = "Purpose Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. Method Chest X-rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression. Results Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p = 0.002) in GTCS with abnormal CXR (259.7 s) versus GTCS with normal CXR (101.2 s). Odds-ratio for CXR abnormality was 20.46 (p = 0.006) with seizure duration greater than 100 s versus less than 100 s. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p = 0.015). Conclusion Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP.",
keywords = "Convulsion, Pulmonary edema, Seizure, SUDEP",
author = "Jeffrey Kennedy and Hardin, {Kimberly A} and Palak Parikh and Chin-Shang Li and Masud Seyal",
year = "2015",
month = "4",
day = "1",
doi = "10.1016/j.seizure.2015.02.023",
language = "English (US)",
volume = "27",
pages = "19--24",
journal = "Seizure : the journal of the British Epilepsy Association",
issn = "1059-1311",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration

AU - Kennedy, Jeffrey

AU - Hardin, Kimberly A

AU - Parikh, Palak

AU - Li, Chin-Shang

AU - Seyal, Masud

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Purpose Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. Method Chest X-rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression. Results Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p = 0.002) in GTCS with abnormal CXR (259.7 s) versus GTCS with normal CXR (101.2 s). Odds-ratio for CXR abnormality was 20.46 (p = 0.006) with seizure duration greater than 100 s versus less than 100 s. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p = 0.015). Conclusion Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP.

AB - Purpose Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit. Method Chest X-rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression. Results Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p = 0.002) in GTCS with abnormal CXR (259.7 s) versus GTCS with normal CXR (101.2 s). Odds-ratio for CXR abnormality was 20.46 (p = 0.006) with seizure duration greater than 100 s versus less than 100 s. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p = 0.015). Conclusion Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP.

KW - Convulsion

KW - Pulmonary edema

KW - Seizure

KW - SUDEP

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U2 - 10.1016/j.seizure.2015.02.023

DO - 10.1016/j.seizure.2015.02.023

M3 - Article

AN - SCOPUS:84929994384

VL - 27

SP - 19

EP - 24

JO - Seizure : the journal of the British Epilepsy Association

JF - Seizure : the journal of the British Epilepsy Association

SN - 1059-1311

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