1
|
Lacuey N, Talavera B, Magana-Tellez O, Mancera-Páez O, Hupp N, Luo X, Hampson JP, Hampson J, Rani RS, Ochoa-Urrea M, Alamoudi OA, Melius S, Pati S, Gavvala J, Tandon N, Mosher JC, Lhatoo SD. Ictal Central Apnea Is Predictive of Mesial Temporal Seizure Onset: An Intracranial Investigation. Ann Neurol 2024; 95:998-1008. [PMID: 38400804 PMCID: PMC11061876 DOI: 10.1002/ana.26888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/27/2023] [Accepted: 01/23/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Ictal central apnea (ICA) is a semiological sign of focal epilepsy, associated with temporal and frontal lobe seizures. In this study, using qualitative and quantitative approaches, we aimed to assess the localizational value of ICA. We also aimed to compare ICA clinical utility in relation to other seizure semiological features of focal epilepsy. METHODS We analyzed seizures in patients with medically refractory focal epilepsy undergoing intracranial stereotactic electroencephalographic (SEEG) evaluations with simultaneous multimodal cardiorespiratory monitoring. A total of 179 seizures in 72 patients with reliable artifact-free respiratory signal were analyzed. RESULTS ICA was seen in 55 of 179 (30.7%) seizures. Presence of ICA predicted a mesial temporal seizure onset compared to those without ICA (odds ratio = 3.8, 95% confidence interval = 1.3-11.6, p = 0.01). ICA specificity was 0.82. ICA onset was correlated with increased high-frequency broadband gamma (60-150Hz) activity in specific mesial or basal temporal regions, including amygdala, hippocampus, and fusiform and lingual gyri. Based on our results, ICA has an almost 4-fold greater association with mesial temporal seizure onset zones compared to those without ICA and is highly specific for mesial temporal seizure onset zones. As evidence of symptomatogenic areas, onset-synchronous increase in high gamma activity in mesial or basal temporal structures was seen in early onset ICA, likely representing anatomical substrates for ICA generation. INTERPRETATION ICA recognition may help anatomoelectroclinical localization of clinical seizure onset to specific mesial and basal temporal brain regions, and the inclusion of these regions in SEEG evaluations may help accurately pinpoint seizure onset zones for resection. ANN NEUROL 2024;95:998-1008.
Collapse
Affiliation(s)
- Nuria Lacuey
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Blanca Talavera
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Oman Magana-Tellez
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Oscar Mancera-Páez
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Norma Hupp
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Xi Luo
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
- Department of Biostatistics and Data Science, University of Texas Health Science Center (UTHealth), School of Public Health, Houston, Texas, USA
| | - Johnson P. Hampson
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Jaison Hampson
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - R. Sandhya Rani
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Manuela Ochoa-Urrea
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Omar A. Alamoudi
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
- Biomedical Engineering Program, Faculty of Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Stephen Melius
- Memorial Hermann, Texas Medical Center, Houston, TX, USA
| | - Sandipan Pati
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Jay Gavvala
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Nitin Tandon
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - John C. Mosher
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Samden D. Lhatoo
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| |
Collapse
|