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Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...
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Generation and On-Demand Initiation of Acute Ictal Activity in Rodent and Human Tissue
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Pontine hyperperfusion associated with ictal central apnea.

Vasileios Kokkinos1,2, Stephen A VanHaerents1,2, Cody L Nathan1,2

  • 1Comprehensive Epilepsy Center, Northwestern Memorial Hospital, Chicago, Illinois, USA.

Epileptic Disorders : International Epilepsy Journal with Videotape
|May 23, 2025
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Summary

Ictal single-photon emission computed tomography (SPECT) revealed anterior pons hyperperfusion in a patient with focal epilepsy and ictal central apnea (ICA). This finding may indicate regions associated with ICA and sudden unexpected death in epilepsy risk.

Keywords:
SPECTepilepsyictal central apneaseizures

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Area of Science:

  • Neurology
  • Epileptology
  • Neuroimaging

Background:

  • Focal epilepsy can present with complex seizure semiologies.
  • Ictal central apnea (ICA) is a rare but serious complication of focal seizures.
  • Identifying the ictal onset zone is crucial for epilepsy surgery.

Purpose of the Study:

  • To report ictal SPECT findings in a patient with focal epilepsy and ICA.
  • To investigate the utility of ictal SPECT in localizing seizure onset in the presence of ICA.
  • To highlight potential imaging markers for ICA and associated risks.

Main Methods:

  • Case report of a 38-year-old female with left posterior quadrant epilepsy and ICA.
  • Continuous EEG monitoring and ictal SPECT during a typical seizure with ICA.
  • Tracer administration timed relative to ICA onset, EEG onset, and clinical changes.
  • Analysis of SPECT findings for hyperperfusion patterns.

Main Results:

  • Ictal SPECT demonstrated significant hyperperfusion in the anterior pons.
  • Mild left > right lateralization of hyperperfusion was observed.
  • The SPECT findings correlated with seizure onset and ICA development.

Conclusions:

  • Ictal SPECT can highlight brain regions associated with ICA in focal epilepsy.
  • Pontine hyperperfusion on ictal SPECT may be an imaging marker for ICA.
  • Increased vigilance for pontine hyperperfusion is recommended due to the risk of sudden unexpected death in epilepsy (SUDEP).