Drops In Blood Oxygen Levels May Be Key To Sudden Death In Some Epilepsy Patients

[brain]

Drops In Blood Oxygen Levels May Be Key To Sudden Death In Some Epilepsy Patients

Drops In Blood Oxygen Levels May
Be Key To Sudden Death In Some Epilepsy Patients

ScienceDaily ( Nov. 25, 2008 ) — A new study by researchers at UC Davis Medical Center suggests that the sudden unexplained deaths of some epilepsy patients may be a result of their brains not telling their bodies to breathe during seizures.

"Significant drops in blood oxygen levels are more common than we thought in patients with partial seizures," said study senior author Masud Seyal, a professor of neurology at UC Davis Medical Center and director of the UC Davis Comprehensive Epilepsy Program.

The study, published online in the Oct. 24 issue of the journal Brain, studied S U D E P, what doctors call Sudden Unexplained Death in Epilepsy for short, to examine deaths of epileptics not explained by repeated convulsive seizures, accidents or other mishaps.

"What we've known for a long time is that Sudden Unexplained Death in Epilepsy appears to be the most important cause of increased mortality in epilepsy patients. What we haven't known is what causes it," Seyal said.

The findings suggest that some cases of Sudden Unexplained Death in Epilepsy may result from the brain not signaling the patient to continue breathing during seizures, though more conclusive evidence is needed, he said.

"It may have to do with an abnormal heart rhythm or it just may be that the brain stops sending the proper signals to maintain normal breathing," Seyal said.

In the retrospective study, Seyal and his colleagues examined records of 300 seizures in 57 epilepsy patients with chronic, recurrent, unprovoked seizures. They compared patients with severe convulsive seizures to those with milder symptoms like transient confusion, lip smacking and head turning.

One-third of all seizures were associated with drops in blood-oxygen levels below 90 percent. Seyal said he was surprised to find that 12 percent of these patients' blood oxygen levels actually dropped below 70 percent during their seizures.

They also discovered that seizures in the temporal lobe of the brain are more often associated with significant drops in blood-oxygen levels and that males are more likely than females to experience dangerously low levels of oxygen during seizures.

The findings support the idea that some cases of Sudden Unexplained Death in Epilepsy may be caused by a lack of brain signaling that makes the patient keep breathing, though scientists need to do more research before they know for sure, Seyal said.

The study is important, Seyal said, because it suggests that hospitals that monitor inpatients for seizures should use both continuous blood-oxygen monitoring that sets off alarms when blood levels are too low and around-the-clock monitoring by staff or relatives.

In a hospital setting, blood-oxygen levels below 85 percent require intervention, such as giving supplemental oxygen, turning the patient on his side or suctioning the patient's airway, to help the patient breathe.

Patients hospitalized for seizure monitoring in the UC Davis Comprehensive Epilepsy Program must have a relative or friend with them around the clock who can recognize their seizures and summon assistance when they occur, in addition to constant blood-oxygen monitoring.

Some medical centers also use video monitors that are continuously monitored by hospital staff. But many do not employ this kind of close monitoring.

"Our data show that it's important that respiratory parameters be closely monitored in the hospital," Seyal said.

The best strategy to reduce the likelihood of Sudden Unexplained Death in Epilepsy is to promptly and effectively control patients' seizures, Seyal said.

Most seizures can be stopped with medication. Patients with seizures poorly controlled with medication often are candidates for surgery, which can have a high success rate. To perform the surgery, however, patients must be observed in the hospital, their medication must be reduced and seizures allowed to take place.

"This is the only way we can pinpoint the region of the brain responsible for the seizures and know where to operate," he said.

Seyal and his colleagues are working to determine the best ways to deal with patients who have severe drops in oxygen levels with seizures.

"The important thing here is to see how we can intervene to deal with the hypoxemia when it happens," he said.

Other UC Davis study authors include Lisa Bateman, assistant professor of neurology and Chin-Shang Li, associate professor of public health sciences. Data analysis for the study was partially funded by grants from the National Institutes of Health (NIH).


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Adapted from materials provided by University of California - Davis - Health System.

[Stacy]

This is very interesting...

What about telling a person to BREATHE when they are having seizures. Would that tell their brain to tell them to breathe? Now this is relying on the fact that there is someone to tell them to breathe. If the person is alone, this obviously is not going to happen.

What about telling yourself to breathe.... often, so that your brain gets used to it? I know it may sound off base, but i tell myself to breathe and concentrate on it every night.

the last seizure i had was very small and only one. I had all my faculties back within 1.5 hours and was able to get up and go take pictures for the local school fund raiser. (They got $93,000... but I did NOT pay $1,700 for a parking space like some people. In fact, I got in free because I took pictures)

[RobinN]

I have wondered the same thing Stacy. If I whispered to Rebecca to breath would she hear me? I know most of the time her friends are with her at school, and they make sure her head is on something soft and they talk to her. This is a scary thought though. I know it was on my mind when I witnessed the first one.

We have big fundraisers at our schools too. I have never paid for a parking space, but we did buy a trip in a news helicopter once. For our sons 16th B-Day.

Good thing you are keeping your seizures wrapped up tight Stacy. We seem to be doing that as well. Rebecca is still doing NFB, just not as consistent as we would like it to be.

[hawke86]

Very interesting article.

[epileric]

When I had a seizure in my doctors office he made the receptionist run & get the oxygen mask for me. I thought it was a bit of an over reaction but he might have known more than most doctors.

Re. telling someone to breathe..... I tend to hyperventilate during a seizure so I have to tell myself to hold my breath for a second to stop it. No reason why the opposite wouldn't be true.

[brain]

I've had times when they had to use Oxygen on
me to force it but I cannot understand how one
can "force" it up the brain. This part here is what
bewilders me.

What I do not get is this part here:

They stick the oxymeter on my finger, and my head
is up here, what's going on in my finger down there
isn't exactly what's going on up there in my head.
And one time, the ER Doctor decided to move it to
my toe to see what the reading was, and ...



It came up a totally different reading, then he moved
it over to the other finger, and it varied from the
reading from the other finger! And he left the room
in a puzzled state, insomuch I had blood work done;
and that was a major *ouch*, for they didn't just
need the typical surface vein, they also needed the
deep down vein as well... *groan*

Then to top it off, they did both veins on the sides
of my neck, just a little bit. I had a lot of lab work done
on that time - and while it took a long time for all the
results to return; the Doctor came back and talked
with us (ex) husband and I, and how the results were
all varied and different. He never said or implied much
of anything except he was going to let the Neurologist
and Cardiologist review all of this and make the decision
if I stay or go; but if i remember correctly, I think my
Cardiologist increased the Tenormin and the Neurologist
ordered the EEG run and increased the Dilantin, and that
was a long time ago ....

As for the oxy-thingies...
just exactly how "reliable" are they? I wonder?

[KellyD]

Ok so this scares the crap out of me because my son tends not to breathe during his seizures. When I am talking to him during his seizure I'm always telling to take a breath and praise him when he does (sounds dumb i know but he is 1 so he gets praised for everything he does right!) I always comforted myself with the thought that if his seizure lasts too long and he doesn't get a breath he will just pass out and his brain will tell him to start breathing again.....

[Bernard]

Ok so this scares the crap out of me because my son tends not to breathe during his seizures.

That's pretty common. My wife will stop breathing for 10 seconds or so when she has a tonic clonic seizure. She might stop breathing for 1-5 seconds when having a complex partial seizure.

This might be part of a natural mechanism whereby the body is trying to increase levels of CO2 in the brain to stop the seizure activity. See Shutting Down Seizure Activity for more info.

[brain]

Bernard is absolutely correct, I also go through
this phase as well, and please DO click on the
link and read more about it.

[ziggidypoo]

And he left the room
in a puzzled state, insomuch I had blood work done;
and that was a major *ouch*, for they didn't just
need the typical surface vein, they also needed the
deep down vein as well... *groan*

Sometimes when blood oxygen levels are done, they do an arterial stick, and the arteries lie right next to major nerves, so there is unbelievable pain - I always pray before they do it.

Having COPD, sleep apnea, and E, and smoker (almost stopped - yeah Chantix), they always test my blood-ox levels doing the arterial stick - I about freak everytime I see them knowing what's ahead.

How Carey helps me w/ my seizures is during the aura time - I run and empty my bladder, while he is putting a pad on the bad for further oops, and turns on my cpap/o2 machines and gets my mouth guard ready for me, then to bed. Usually this either aborts the seizure or I sleep through it or something.

???????????????

******************************

In reading the above posts on CO2 to stop seizures, it brings me back to we are each different and may have other complications in our bodies that what may work for one person may not work for another. If a person has pulmonary problems, CO2 can cause serious problems. Perhaps if a person w/E does not have pulmonary problems the CO2 theory would be effective for THEM.

As they say before starting a diet - check w/ your doctor first.

Smoking (nicotine, CO2, and a zillion other things) causes some seizing in me.

After death in the family due to smoking/cancer and all of my pulmonary probs, I am DILIGENTLY working towards the goal of total cessation of smoking cigarettes.

(please note: ziggy (me) talks alot, jokes alot, and says stupid and potentially inappropriate things alot - please forgive me - I am REALLY working hard on trying to heed the recommendations and "fit in" - for some of us life has formed us - for some of us life has Deformed us (not physically). Thanks for enduring my many ramblings. )