Increased cerebral oxygenation precedes generalized tonic clonic seizures

Based on previous fMRI and SPECT studies, it has been suggested seizures may be preceded by increased cerebral blood flow. Recently, we demonstrated transcutaneous regional cerebral oxygen saturation (rSO2) sensors are feasible for use in patients undergoing video EEG monitoring. We reanalyzed our data to determine if seizures were consistently marked by increased cerebral oxygenation. Patients with histories of generalized tonic clonic seizures (GTCS) were recruited into our study. All subjects were evaluated with continuous 30-channel scalp EEG and 2 rSO2 sensors placed on each side of the forehead. We calculated the mean rSO2 value for the 1 h epochs in the non-ictal (2 h prior to seizure onset) and pre-ictal (1 h prior to onset) periods. Seven primary/secondarily GTCS from 5 patients were captured. The mean rSO2 value in the non-ictal period was 75.6 ± 5.7%. This increased to 76.0 ± 6% in the pre-ictal period (p = 0.032). Four of the 7 GTCS (57.1%) were marked by ≥3 sequential rSO2 values in the pre-ictal period that were ≥3 SDs greater than the mean non-ictal rSO2 value. Three GTCS (42.9%) were marked by sustained cerebral hyperemia for ≥15 consecutive readings. Our results suggest increased cerebral blood flow could be non-invasively used to predict seizure occurrence.