Hewertson J, Poets C F, Samuels M P, Boyd S G, Neville B G, Southall D P
Academic Department of Paediatrics, University of Keele, North Staffordshire Hospital, Stoke-on-Trent, United Kingdom.
Pediatrics. 1994 Aug;94(2 Pt 1):148-56.
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.
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.
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.
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.
描述癫痫发作（ES）诱发的明显危及生命事件（ALTE）期间发生的生理变化，并解释这些事件中低氧血症发生的机制。
从17例婴儿中回顾性选取6例，因为他们在生理记录中有ALTE记录，且信号的首次变化出现在脑电图（EEG）中。这17例婴儿有部分性癫痫发作的临床特征（但标准EEG正常），来自172例反复发生ALTE的婴儿样本。所有17例婴儿均进行了呼吸、心电图（ECG）、氧合和EEG的连续记录，但只有6例记录到了ES诱发的ALTE并描述了生理变化。
6例婴儿记录到23次ALTE。事件始于EEG异常，随后在中位间隔27秒（范围2至147秒）后SaO2下降。尽管进行了复苏，严重低氧血症（SaO2≤60%）的中位持续时间为40秒（范围8至74秒）。在18次事件（5例婴儿）中，SaO2下降前中位有4次呼吸暂停（范围1至9次），中位持续时间为24秒（范围3至48秒）。每次事件中最长的呼吸暂停持续时间中位为19秒（范围8至47秒）。5次事件（4例婴儿）中呼吸运动持续存在，1次事件中有呼气气流。23次事件中的19次（6例婴儿）发现窦性心动过速，但未发现心律失常。
婴儿的ES可表现为ALTE，并伴有潜在危及生命的严重低氧血症和呼吸暂停发作，尽管事件期间EEG正常。
