Abstract | BACKGROUND: METHODS: Video EEGs were reviewed for seizure type, duration and semiology, and electrographic features. To identify predictors of postictal generalized EEG suppression, we identified 40 children with generalized convulsive seizures from a group of 399 patients who experienced an electroclinical seizure during video-EEG. Seventy-seven generalized convulsive seizures with and without postictal generalized EEG suppression were anayzed. RESULTS: Age of seizure onset was older in 19 children with postictal generalized EEG suppression (mean 6.8 years old, 95% CI [4.7-8.9]) than in 21 without postictal generalized EEG suppression (3.0 years old, [1.1-4.1], P = 0.041). Postictal generalized EEG suppression occurred significantly more often from sleep than awake (point of estimate 16.67; 95% CI [0.97-32.36], P < 0.038). Shorter duration of the clonic phase (-0.76; [-1.338, -0.133], P = 0.018) was significantly associated with postictal generalized EEG suppression. Ictal symmetric tonic extension posturing significantly increased the odds of postictal generalized EEG suppression (42.94; [18.77, 67.12], P = 0.001). All 15 generalized convulsive seizures with a terminal burst-suppression pattern were followed by postictal generalized EEG suppression in contrast to 19 of 62 generalized convulsive seizures without burst-suppression (15.32, P < 0.001). CONCLUSIONS: Ictal decerebrate-like symmetric tonic extension posturing with shorter clonic phase and a terminal burst-suppression pattern identify malignant generalized convulsive seizures, associated with postictal generalized EEG suppression and a potentially increased risk of sudden unexpected death in epilepsy.
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Authors | Kazuo Okanari, Hiroshi Otsubo, Elizabeth Kouzmitcheva, Jagadish Rangrej, Shiro Baba, Ayako Ochi, Tohru Okanishi, Yoichiro Homma, Dragos A Nita, Elizabeth J Donner |
Journal | Pediatric neurology
(Pediatr Neurol)
Vol. 76
Pg. 54-59
(Nov 2017)
ISSN: 1873-5150 [Electronic] United States |
PMID | 28967460
(Publication Type: Journal Article)
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Copyright | Copyright © 2017 Elsevier Inc. All rights reserved. |
Topics |
- Brain Waves
(physiology)
- Child
- Child, Preschool
- Death, Sudden
- Electroencephalography
- Epilepsy
(complications)
- Female
- Humans
- Infant
- Infant, Newborn
- Male
- Postural Balance
(physiology)
- Sensation Disorders
(etiology)
- Sleep
(physiology)
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