Department of Neurology, University of California, Davis, California.
Department of Neurological Surgery, University of California, Davis, California.
Epilepsia. 2020 Jun;61(6):1253-1260. doi: 10.1111/epi.16518. Epub 2020 May 11.
Sudden unexpected death in epilepsy (SUDEP) is a frequent cause of death in epilepsy. Respiratory dysfunction is implicated as a critical factor in SUDEP pathophysiology. Human studies have shown that electrical stimulation of the amygdala resulted in apnea, indicating that the amygdala has a role in respiration control. Unilateral amygdala stimulation resulted in immediate onset of respiratory dysfunction occurring only during nose breathing. In small numbers of patients, some but not all spontaneous seizures resulted in apnea occurring shortly after seizure spread to the amygdala. With this study we aimed to determine whether seizure onset or spread to the amygdala was necessary and sufficient to cause apnea.
We investigated the temporal relationship between apnea/hypopnea (AH) onset and initial seizure involvement within the amygdala in patients with implanted depth electrodes.
Data from 17 patients (11 female) with 47 seizures were analyzed. With seven seizures (three patients), AH preceded amygdala seizure involvement by 2 to 55 seconds. There was no AH with four seizures (three patients) that involved the amygdala. With eight seizures (four patients) AH occurred within 2 seconds following amygdala seizure onset. With 28 seizures, AH started >2 seconds after amygdala seizure onset (range 3-158 seconds). Following seizure onset, there was a significant difference between AH onset time and amygdala seizure onset (P < .001). The mean ± standard deviation (SD) AH onset was 27.8 ± 41.06 seconds, and the mean time to amygdala involvement was 8.83 ± 20.19 seconds.
There is a wide range of AH onset times relative to amygdala seizure involvement. With some seizures, amygdala seizure involvement occurs without AH. With other seizures, AH precedes amygdala seizures, suggesting that, with spontaneous seizures, involvement of the amygdala may not be crucial to induction of AH with all seizures. Other pathophysiology impacting brainstem respiratory networks may be of greater relevance to seizure-triggered apneas.
癫痫猝死（SUDEP）是癫痫患者常见的死亡原因。呼吸功能障碍被认为是 SUDEP 病理生理学中的一个关键因素。人体研究表明，杏仁核的电刺激会导致呼吸暂停，表明杏仁核在呼吸控制中起作用。单侧杏仁核刺激会导致呼吸功能障碍立即发作，仅在鼻呼吸时发生。在少数患者中，一些但不是所有的自发性癫痫发作都会导致呼吸暂停，这些呼吸暂停发生在癫痫扩散到杏仁核后不久。通过这项研究，我们旨在确定癫痫发作的开始或扩散到杏仁核是否是导致呼吸暂停的必要和充分条件。
我们研究了植入深度电极的患者中呼吸暂停/低通气（AH）发作与杏仁核内初始癫痫发作之间的时间关系。
分析了 17 名患者（11 名女性）的 47 次癫痫发作的数据。在 7 次癫痫发作（3 名患者）中，AH 发生在杏仁核癫痫发作前 2 至 55 秒。在 4 次癫痫发作（3 名患者）中没有 AH，这些癫痫发作涉及杏仁核。在 8 次癫痫发作（4 名患者）中，AH 发生在杏仁核癫痫发作开始后 2 秒内。在 28 次癫痫发作中，AH 在杏仁核癫痫发作开始后 >2 秒开始（范围 3-158 秒）。癫痫发作开始后，AH 发作时间和杏仁核癫痫发作开始时间之间存在显著差异（P<.001）。AH 发作的平均±标准偏差（SD）为 27.8±41.06 秒，杏仁核参与的平均时间为 8.83±20.19 秒。
AH 发作时间与杏仁核癫痫发作参与之间存在很大的差异。在一些癫痫发作中，杏仁核癫痫发作参与时没有 AH。在其他癫痫发作中，AH 先于杏仁核癫痫发作，这表明在自发性癫痫发作中，并非所有癫痫发作都与杏仁核参与有关，而是与其他影响脑干呼吸网络的病理生理学有关。
