ICTAL APNEA OF EPILEPTIC ORIGIN

Abstract

Epileptic seizures may be associated with changes of autonomic functions such as cardiac rhythm or breathing. Diagnostic problems may occur if only autonomic symptoms represent the epileptic seizure manifestation. Autonomic seizures such as ictal tachycardia have a high localizing value for seizure onset in the temporal region.1 In this report, we present two patients in whom the epileptic origin of central apnea could be established with ictal polygraphic EEG video recordings. ### Case 1. A 53-year-old woman with a history of right partial middle cerebral artery ischemia and early onset left face clonic seizures was admitted to our stroke unit because of transient mild left hemiparesis. MRI revealed an old right paracentral partial infarct of the middle cerebral artery. She was free of the clonic seizures for several months without antiepileptic medication. Polysomnography (PSG) (with nasal thermistor and belts for chest and abdominal movements), which was performed because of sleep apnea episodes, documented 18 central apneas consisting of cessation of airflow and breathing effort with oxygen desaturation of up to 70% associated with right hemisphere EEG seizure pattern (figure). All seizures occurred during sleep and caused awakening. Heart rate during the seizures stayed within the range of night sleep outside the seizures. Oxcarbazepine caused seizure freedom during 3 years follow-up. Figure All-night hypnogram (A) and ictal EEG (B) of patient 1 (A) The upper part …