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Epileptic seizure-induced hypoxemia in infants with apparent life-threatening events
J Hewertson1, C F Poets, M P Samuels
1Academic Department of Paediatrics, University of Keele, North Staffordshire Hospital, Stoke-on-Trent, United Kingdom.
Insights
Epileptic seizures in infants can cause apparent life-threatening events (ALTE) with severe hypoxemia and apnea. These events, linked to EEG abnormalities, highlight a critical link between seizures and breathing disturbances in infants.
Area of Science:
- Pediatric Neurology
- Neonatal Medicine
- Clinical Neurophysiology
Background:
- Apparent life-threatening events (ALTE) in infants often present diagnostic challenges.
- Epileptic seizures (ES) can mimic or trigger ALTE, necessitating detailed physiological investigation.
- Understanding the pathophysiology of ES-induced ALTE is crucial for timely intervention.
Objective:
To describe the physiologic changes that occur during epileptic seizure (ES)-induced apparent life-threatening events (ALTE) and to provide an explanation for the mechanism whereby the hypoxemia characterizing these events occurred.
Patients And Design:
Six infants were retrospectively selected from a group of 17 because they had ALTE documented on physiologic recordings where the first change in signals was in the electroencephalogram (EEG). The 17 infants had clinical features suggestive of partial seizures (but normal standard EEGs) and were from a sample of 172 infants with recurrent ALTE. All 17 infants underwent continuous recordings of breathing, electrocardiogram (ECG), oxygenation, and EEG, but only in 6 was an ES-induced ALTE recorded and the physiologic changes described.
Results:
Twenty-three ALTE were documented in six infants. Events commenced with an abnormality in the EEG, followed by a decrease in SaO2 after a median interval of 27 seconds (range 2 to 147). Despite resuscitation, the median duration of severe hypoxemia (SaO2 < or = 60%) was 40 seconds (range 8 to 74). In 18 events (five infants) there was a median of four apneic pauses (range 1 to 9) preceding the decrease in SaO2 by a median duration of 24 seconds (range 3 to 48). The longest apneic pause per event lasted a median of 19 seconds (range 8 to 47). Breathing movements continued in five events (four infants), and expiratory airflow in one. Sinus tachycardia was found in 19 of the 23 events (six infants), but there were no cardiac arrhythmias.
Conclusions:
ES in infants can manifest as ALTE and be accompanied by potentially life-threatening episodes of severe hypoxemia and apnea, despite a normal EEG between events.