Hypoxemia following generalized convulsive seizures: Risk factors and effect of oxygen therapy.

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Hypoxemia following generalized convulsive seizures: Risk factors and effect of oxygen therapy.

Neurology. 2018 Dec 19;:

Authors: Rheims S, Alvarez BM, Alexandre V, Curot J, Maillard L, Bartolomei F, Derambure P, Hirsch E, Michel V, Chassoux F, Tourniaire D, Crespel A, Biraben A, Navarro V, Kahane P, De Toffol B, Thomas P, Rosenberg S, Valton L, Bezin L, Ryvlin P, REPO2MSE study group

Abstract
OBJECTIVE: To analyze the factors that determine the occurrence or severity of postictal hypoxemia in the immediate aftermath of a generalized convulsive seizure (GCS).
METHODS: We reviewed the video-EEG recordings of 1,006 patients with drug-resistant focal epilepsy included in the REPO2MSE study to identify those with ≥1 GCS and pulse oximetry (SpO2) measurement. Factors determining recovery of SpO2 ≥ 90% were investigated using Cox proportional hazards models. Association between SpO2 nadir and person- or seizure-specific variables was analyzed after correction for individual effects and the varying number of seizures.
RESULTS: A total of 107 GCS in 73 patients were analyzed. A transient hypoxemia was observed in 92 GCS (86%). Rate of GCS with SpO2 <70% dropped from 40% to 21% when oxygen was administered early (p = 0.046). Early recovery of SpO2 ≥90% was associated with early administration of oxygen (p = 0.004), absence of postictal generalized EEG suppression (PGES) (p = 0.014), and extratemporal lobe epilepsy (p = 0.001). Lack of early administration of O2 (p = 0.003), occurrence of PGES (p = 0.018), and occurrence of ictal hypoxemia during the focal phase (p = 0.022) were associated with lower SpO2 nadir.
CONCLUSION: Postictal hypoxemia was observed in the immediate aftermath of nearly all GCS but administration of oxygen had a strong preventive effect. Severity of postictal hypoxemia was greater in temporal lobe epilepsy and when hypoxemia was already observed before the onset of secondary GCS.

PMID: 30568004 [PubMed - as supplied by publisher]

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