Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.
J Clin Neurophysiol. 2009 Oct;26(5):309-15. doi: 10.1097/WNP.0b013e3181b7f14d.
Comonitoring of seizures and respiratory function with pulse oximetry has shown that ictal respiratory changes (IRCs) accompany tonic-clonic convulsions and even partial seizures, especially those of temporal lobe origin. IRCs occur in children and adults, and diminished central drive is frequent, although peripheral obstruction is observed occasionally. Case reports of sudden unexplained death in epilepsy (SUDEP) have suggested IRC as a mechanism. In a series of 15 witnessed SUDEP cases, overt convulsions with marked respiratory difficulty were observed in 12. For two cases, obstructive mechanisms may have predominated. One near-SUDEP case implicated central apnea, but another case implicated postictal laryngospasm. Inhibition of brainstem respiratory control circuits likely subserves IRCs. The pre-Bötzinger complex in the rostral ventrolateral medulla is a key locus for respiratory rhythm generation, with expiratory control neurons near the nucleus ambiguous. Inputs to these neurons descend from the insula, hypothalamus, and reticular formation. Direct stimulation of limbic targets in humans causes apnea. Animal models of focal seizures with IRCs and SUDEP have produced inconsistent results: some support central mechanisms, whereas others implicate peripheral obstruction. Serotonin seems relevant in a mouse model of SUDEP. These models may elucidate how seizures embarrass respiration and possibly predispose patients to SUDEP.
通过脉搏血氧仪对发作和呼吸功能进行联合监测表明，发作期呼吸变化（IRCs）伴随着强直-阵挛性发作，甚至部分发作，特别是起源于颞叶的发作。IRCs 发生在儿童和成人中，尽管偶尔会观察到外周阻塞，但中枢驱动减弱很常见。癫痫伴突发不明原因死亡（SUDEP）的病例报告提示 IRC 是一种机制。在一系列 15 例有目击者的 SUDEP 病例中，12 例观察到明显的呼吸困难和明显的发作性抽搐。对于两种情况，阻塞机制可能占主导地位。一种接近 SUDEP 的情况提示中枢性呼吸暂停，而另一种情况提示发作后喉痉挛。脑干呼吸控制回路的抑制可能是 IRCs 的基础。延髓腹外侧头端的 Pre-Bötzinger 复合体是呼吸节律产生的关键部位，呼气控制神经元位于疑核附近。这些神经元的输入来自脑岛、下丘脑和网状结构。直接刺激人类的边缘靶标会导致呼吸暂停。具有 IRC 和 SUDEP 的局灶性癫痫动物模型得出了不一致的结果：一些支持中枢机制，而另一些则暗示外周阻塞。在 SUDEP 的小鼠模型中，5-羟色胺似乎与之相关。这些模型可以阐明癫痫如何干扰呼吸，并可能使患者易患 SUDEP。
