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Journal Articles Neurology Year : 2019

Hypoxemia following generalized convulsive seizures

Blanca Mercedes Alvarez
  • Function : Author
Veriano Alexandre
  • Function : Author
Jonathan Curot
Vincent Navarro
Pierre Thomas
  • Function : Author
  • PersonId : 921141
Luc Valton

Abstract

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 REPO2MSE study to identify those with ≥1 GCS and pulse oximetry (SpO2) measurement. Factors determining recovery of SpO2 ≥ 90% were investigated using Cox proportional hazards models. Association between SpO2 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 SpO2 <70% dropped from 40% to 21% when oxygen was administered early (p = 0.046). Early recovery of SpO2 ≥90% was associated with early administration of oxygen (p = 0.004), absence of postictal generalized EEG suppression (PGES) (p = 0.014), and extratemporal lobe epilepsy (p = 0.001). Lack of early administration of O2 (p = 0.003), occurrence of PGES (p = 0.018), and occurrence of ictal hypoxemia during the focal phase (p = 0.022) were associated with lower SpO2 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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Dates and versions

hal-02103601 , version 1 (18-04-2019)

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Sylvain Rheims, Blanca Mercedes Alvarez, Veriano Alexandre, Jonathan Curot, Louis Maillard, et al.. Hypoxemia following generalized convulsive seizures. Neurology, 2019, 92 (3), pp.183-193. ⟨10.1212/WNL.0000000000006777⟩. ⟨hal-02103601⟩
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