Multimodality peak lctal vital signs during video-EEG monitoring

Purpose To assess and compare peak, multimodal ictal vital signs (iVS) during epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES). Methods Between 4/1/2010 and 4/1/2011, 183 adults had video-EEG monitoring, with 96 consecutive patients meeting inclusion criteria. Heart rate (HR), oxygen saturation (SaO₂), and blood pressure (BP) were obtained at baseline and during an ictus. The motor semiology of each ES and PNES was also assessed. Student t-test, Fischer's Test, Wilcoxon Test (p = <0.05), and linear regression provided statistical correlation. Results The 46 patients with ES and 50 patients with PNES had similar baseline VS. Generalized tonic-clonic ES had the highest absolute iVS. ES yielded a higher absolute ictal HR (p = 0.0004) and lower SaO₂ nadir (p = 0.003) than PNES. Systolic and diastolic BP did not differ between groups (p = NS). The upper ranges of iS-BP attained a maximum value of 195/135 mm Hg in ES and 208/128 mmHg in PNES. For ES, the change in ictal HR was inversely correlated with a reduction in ictal SaO₂ (CC = -0.4; p = 0.003). In PNES, ictal HR correlated with systolic BP (CC = 0.6; p = <0.0001), but not ictal SaO₂. Conclusion The inverse relationship between ictal HR and ictal SaO₂ in ES suggests a neurobiological difference, and the concept of intrinsic cardio-respiratory dysfunction in patients with epilepsy. The significantly raised peak elevations in ictal HR and ictal systolic BP during PNES demonstrates the potential for serious adverse outcomes if attacks are prolonged.