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Area of Science:

  • Neuroscience
  • Epileptology
  • Respiratory Physiology

Background:

  • Cortical control of breathing is not fully understood.
  • Ictal central apnea (ICA) during seizures is a significant concern, potentially linked to sudden unexpected death in epilepsy (SUDEP).

Purpose of the Study:

  • To precisely identify cortical regions that modulate breathing.
  • To delineate the network of cortical structures involved in ictal central apnea (ICA) during epileptic seizures.

Main Methods:

  • Electrical stimulation of various cortical structures in patients undergoing stereotactic EEG (SEEG) evaluation.
  • Continuous monitoring of respiratory parameters including chest/abdominal excursions, oxygen saturation, and carbon dioxide levels.

Main Results:

  • Stimulation of the amygdala, hippocampus, anterior parahippocampal gyrus, and antero-mesial fusiform gyrus elicited transient central apnea in 13/19 patients.
  • Stimulation of other investigated cortical areas did not induce apnea.
  • Apnea duration correlated significantly with stimulus duration and current intensity.

Conclusions:

  • A limbic/paralimbic mesial temporal network (amygdala, hippocampus, anterior parahippocampal, and antero-mesial fusiform gyri) modulates breathing.
  • These structures are likely substrates for ICA and may serve as a breathing biomarker for SUDEP risk.
  • Targeting these structures in SEEG and analyzing peri-ictal breathing can improve epilepsy surgery outcomes.