Postictal Generalized EEG Suppression as a Biomarker for SUDEP: Nancy R. Foldvary-Schaefer, DO, FAAN


The director of the Sleep Disorders Center and staff in the Epilepsy Center at Cleveland Clinic discussed how additional sensors in seizure monitoring for patients with epilepsy may help better manage the risk of SUDEP. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

“It’s important for epileptologists to recognize that some patients with epilepsy are potentially at risk for these significant changes associated with their seizures. We are not there yet in most epilepsy monitoring units… I think this is part of the research that will help us understand how important it may be to add some of these sensors when we’re recording seizures, and it’s part of the bigger story of these bidirectional relationships between sleep and epilepsy.”

Literature has suggested that sudden unexpected death in epilepsy (SUDEP), which often occurs during sleep, may be influenced by seizure-related respiratory dysfunction. Although, much of this research has been based largely on scalp recordings and lacks comprehensive polysomnographic (PSG) signal reporting. Peri-ictal respiratory disturbances associated with postictal generalized electroencephalography suppression (PGES)—defined as an absence of EEG activity greater than 10μV—have been proposed as a biomarker of promise for SUDEP.

At the 2023 American Academy of Neurology (AAN) Annual Meeting, April 22-27, in Boston, Massachusetts, data were presented from a study of 29 patients (61 seizures) that used stereo EEG to record perisylvian seizures and showed that PGES—and not sleep—is associated with numerous respiratory disturbances, namely higher central event frequency (P <.001) and duration (P = .010), higher ictal relative risk (RR)(P <.001), preictal-to-ictal RR change (P <.001), preictal-to-peak transcutaneous carbon dioxide gas pressure (TcpCO2) change (P = .023), and greater preictal-to-nadir SpO2 change (P = .033). PGES was not associated, however, with sleep state.

To find out more about this assessment and its implications for clinical care, NeurologyLive® spoke with study author Nancy R. Foldvary-Schaefer, DO, FAAN, the director of the Sleep Disorders Center and staff in the Epilepsy Center at Cleveland Clinic, and a professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, in Ohio. Foldvary-Schaefer explained the motivation for conducting the study among this population of patients with epilepsy, expanded on the known relationship between sleep and epilepsy, and provided further context on the findings.

Click here for more coverage on AAN 2023.

Munoz LM, Grigg-Damberger MM, Foldvary-Schaefer NR, et al. Post Ictal Generalized EEG suppression, Not Sleep State, is Associated with Peri-Ictal Respiratory Disturbances in Stereoelectroencephalography Recorded Perisylvian Seizures. Presented at: 2023 AAN Annual Meeting; April 22-27, Boston, Massachusetts.
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