Severe, Non-Apneic Respiratory Dysfunction and Hypoxia Following Generalized Convulsive Seizures

Authors

• Haley E Pysick
• Rup K Sainju
• Roshni Nair
• Deidre N Dragon
• Eduardo Bravo
• Laura Vilella
• Xiaojin Li
• Samden D Lhatoo
• George B Richerson
• Brian K Gehlbach

Language

English

Publication Date

5-1-2026

DOI

10.1002/ana.78164

PMID

41589457

PMCID

PMC12885573

PubMedCentral® Posted Date

1-27-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Objective: Sudden unexpected death in epilepsy (SUDEP) is a devastating consequence of some generalized convulsive seizures (GCS). Recent work has focused on seizure related apnea as a biomarker of SUDEP risk, frequently without characterizing the adequacy of non-apneic ventilation or identifying other dysfunctional breathing patterns. We hypothesized that GCS frequently induce immediate, severe, non-apneic respiratory dysfunction that can induce critical hypoxia and bradycardia and sought to characterize breathing patterns after GCS.

Methods: Adult patients admitted to an epilepsy monitoring unit were studied. The effects of GCS on breathing and heart rate were analyzed using nasal pressure transducers, chest and abdominal respiratory inductance plethysmography, capillary oxygen saturation, transcutaneous CO2, electrocardiogram, electroencephalogram, and expert audiovisual analysis. Correlation analyses, the Mann-Whitney test, and an unpaired t test were used to analyze relationships between dysfunctional breathing patterns and both the severity of postictal hypoxemia and the heart rate.

Results: Thirty-two GCS from 22 patients were analyzed and 31 exhibited 1 or more of the following breathing patterns: disordered rhythmicity (n = 28/32, 87.5%), shallow breathing (n = 12/32, 37.5%), thoracoabdominal asynchrony (n = 24/30, 80.0%), and upper airway obstruction (n = 30/32, 93.8%). Oxygen desaturation was more severe when postictal breathing was shallow or irregular in amplitude. The latter was associated with absolute or relative bradycardia.

Interpretation: Nonfatal GCS frequently induce immediate, severe, non-apneic respiratory dysfunction temporally associated with severe hypoxia and bradycardia. Our study suggests that postictal respiratory and cardiac function are tightly coupled and highlights the importance of including all the relevant pathologic variables in studies of SUDEP pathogenesis. ANN NEUROL 2026;99:1263-1276.

Keywords

Humans, Male, Female, Adult, Hypoxia, Middle Aged, Respiration Disorders, Heart Rate, Young Adult, Seizures, Epilepsy, Generalized, Sudden Unexpected Death in Epilepsy, Electroencephalography, Electrocardiography

Published Open-Access

yes

Recommended Citation

Pysick, Haley E; Sainju, Rup K; Nair, Roshni; et al., "Severe, Non-Apneic Respiratory Dysfunction and Hypoxia Following Generalized Convulsive Seizures" (2026). Faculty, Staff and Student Publications. 3780.
https://digitalcommons.library.tmc.edu/uthmed_docs/3780