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. 2015 Apr:27:19-24.
doi: 10.1016/j.seizure.2015.02.023.

Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration

Jeffrey D Kennedy  1 , Kimberly A Hardin  2 , Palak Parikh  1 , Chin-Shang Li  3 , Masud Seyal  1
Affiliations

Pulmonary edema following generalized tonic clonic seizures is directly associated with seizure duration

Jeffrey D Kennedy et al. Seizure. 2015 Apr.

Abstract

Purpose: Postictal pulmonary edema (PPE) is almost invariably present in human and animal cases of sudden unexpected death in epilepsy (SUDEP) coming to autopsy. PPE may be a contributing factor in SUDEP. The incidence of postictal PPE is unknown. We retrospectively investigated PPE following generalized tonic clonic seizures (GTCS) in the epilepsy monitoring unit.

Methods: Chest X-Rays (CXR) following each GTCS were obtained in 24 consecutive patients. Relationship of CXR abnormality to seizure duration, ictal/postictal oxygen desaturation (SpO2), apnea and presence of postictal generalized EEG suppression (PGES) was investigated using logistic regression.

Results: Eleven of 24 patients had CXR abnormalities following a GTCS. In these 11 patients, 22 CXR were obtained and abnormalities were present in 15 CXR. Abnormalities included PPE in 7 patients, of which 2 also had focal infiltrates. In 4 patients focal infiltrates were present without PPE. There was no significant difference in mean time to CXR (225 min) following GTCS in the abnormal CXR group versus the normal group of patients (196 min). Mean preceding seizure duration was longer (p=0.002) in GTCS with abnormal CXR (259.7 sec) versus GTCS with normal CXR (101.2 sec). Odds-ratio for CXR abnormality was 20.46 (p=0.006) with seizure duration greater than 100 sec versus less than 100 sec. On multivariable analysis, only the seizure duration was a significant predictor of CXR abnormality (p=0.015).

Conclusions: Radiographic abnormalities are not uncommon following GTCS. The presence of CXR abnormality is significantly associated with the duration of the preceding GTCS. Severe, untreated PPE may be relevant to the pathophysiology of SUDEP.

Keywords: Convulsion; Pulmonary Edema; SUDEP; Seizure.

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Conflict of interest statement

Conflicts of interest: none.

Figures

Figure 1
Figure 1. Probability of CXR Abnormality Versus Seizure Duration
The large circles are the estimated probability for CXR abnormality for a given seizure duration. The small filled circles are the upper and lower point-wise 95% confidence intervals versus seizure duration time.
Figure 2
Figure 2. CXR in 3 patients demonstrating varying degrees of pulmonary edema
A. 38 year old male, 299 second right hemisphere onset seizure with secondary generalization. CXR obtained 39 minutes after end of seizure. B. 47 year old female, 263 second left frontal seizure with secondary generalization. CXR obtained 143 minutes after end of seizure. C. 54 year old woman, 202 second right frontal seizure with secondary generalization. CXR obtained 30 minutes after end of seizure. The patient had 2 other GTCS in the 3 hours prior this seizure and no CXR was obtained. A routine CXR earlier that day preceding the GTCS had shown no evidence of pulmonary edema. The patient had a seizure-related takotsubo dilated cardiomyopathy and had a cardiac pacemaker implanted. D. Repeat CXR in patient C obtained the next day showing improving pulmonary edema.
See this image and copyright information in PMC

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