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Brainstem Respiratory Center Dysfunction in Persons With Epilepsy: An fMRI Study.

Carolina Ciumas1, Romain Bouet2, Andrea O Rossetti1

  • 1Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland.

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|February 10, 2026
PubMed
Summary
This summary is machine-generated.

Persons with epilepsy (PWE) show reduced brainstem activation during breath-holding tasks compared to controls. This breath-holding functional MRI (fMRI) finding may help identify individuals at risk for sudden unexpected death in epilepsy (SUDEP).

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Area of Science:

  • Neuroscience
  • Respiratory Physiology
  • Epilepsy Research

Background:

  • Peri-ictal apnea is common in persons with epilepsy (PWE) and linked to sudden unexpected death in epilepsy (SUDEP).
  • Brainstem respiratory center response to apnea in PWE is not well understood.
  • Breath-holding (BH) functional MRI (fMRI) can investigate brainstem function during apnea.

Purpose of the Study:

  • To investigate differences in brainstem respiratory center activation between PWE and healthy controls during voluntary BH tasks.
  • To explore the potential of BH-fMRI as a biomarker for detecting respiratory control dysfunction in PWE.

Main Methods:

  • Adult PWE and healthy controls underwent fMRI during inspiratory and expiratory BH tasks.
  • Respiratory rate, oxygen saturation, and end-tidal gases were monitored.
  • Group-level and individual-level analyses of brainstem activation and connectivity were performed using fMRI data.

Main Results:

  • PWE exhibited significantly lower group-level brainstem activation during both expiratory and inspiratory BH compared to controls.
  • Individual analyses revealed reduced brainstem activation in 35% of PWE, particularly in the cuneiform and median raphe nuclei.
  • Reduced brainstem-cortical connectivity was observed in PWE during both breathing and BH.

Conclusions:

  • A significant proportion of PWE display interictal dysfunction in brainstem respiratory control regions.
  • BH-fMRI can detect these abnormalities at the individual level, suggesting potential as a clinical biomarker.
  • Further research is needed to validate these findings and explore their link to SUDEP.