Ictal central apneas in temporal lobe epilepsies

Area of Science:

• Neurology
• Sleep Medicine
• Epileptology

Background:

• Temporal lobe epilepsy (TLE) is a common focal epilepsy.
• Ictal central apnea (ICA) is a known complication of seizures.
• Previous studies on ICA frequency in TLE are limited.

Purpose of the Study:

• To determine the frequency and characteristics of ictal central apnea (ICA) in patients with mesial or neocortical TLE.
• To investigate the timing of ICA relative to electroencephalography (EEG) and clinical seizure onset.
• To assess the value of multimodal respiratory monitoring in TLE.

Main Methods:

• Retrospective analysis of 453 patients undergoing EEG with cardiorespiratory monitoring.
• Inclusion of patients with confirmed TLE via MRI and/or invasive recordings.
• Analysis of 164 seizures from 41 TLE patients with multimodal respiratory data.

Main Results:

• ICA occurred in 79.9% of analyzed TLE seizures, with no significant difference between mesial and neocortical TLE.
• ICA preceded EEG onset in 33.3% of seizures and clinical onset in 48.7%.
• Longer ICA duration correlated with increased hypoxemia.

Conclusions:

• The frequency of ICA in this TLE cohort is higher than previously reported.
• Multimodal respiratory monitoring is valuable for seizure localization and well-tolerated.
• ICA can precede both EEG and clinical seizure manifestation, emphasizing its diagnostic importance.