Periictal autonomic dysfunction and generalized postictal EEG suppression in convulsive seizures arising from sleep and wakefulness

- Preictal heart rate was lower in patients with nocturnal GCSs than in those with diurnal GCSs.
- Postictal heart rate and respiratory rate were comparable in patients with nocturnal and diurnal GCSs.
- Prevalence and duration of PGES were also comparable in patients with nocturnal and diurnal GCSs.
- SUDEP risk during sleep may not be attributable to postictal autonomic dysfunction and PGES.

Sleep appears to be an independent risk factor of sudden unexpected death in epilepsy (SUDEP). We retrospectively determined the periictal electrophysiological characteristics of nocturnal and diurnal generalized convulsive seizures (GCSs) in 109 patients. Our data showed that preictal heart rate (HR) was significantly lower in 46 patients with nocturnal GCSs than in 63 patients with diurnal GCSs (p = 0.002). However, there was no significant difference in postictal HR and respiratory rate (RR), total seizure duration, total convulsive phase, tonic phase, and clonic phase. Meanwhile, postictal generalized EEG suppression (PGES) was observed in 52.4% of the patients with diurnal GCSs and 67.4% of the patients with nocturnal GCSs. Duration of PGES was 38.2 ± 17.3 s in patients with diurnal GCSs and 49.5 ± 21.7 s in patients with nocturnal GCSs. There was also no significant difference in the prevalence (p = 0.118) and duration (p = 0.044, Bonferroni-corrected significant level: α = 0.00625) of PGES in the two patient groups. Therefore, there is no clear evidence to attribute the SUDEP risk associated with sleep to postictal autonomic dysfunction and PGES, as compared to wakefulness.