In an interview, session comoderator Dr. Amy Crepeau, a neurologist at the Mayo Clinic Arizona in Phoenix, said the observed incidence of pulmonary edema raises important questions: “Is this something we need to be more conscientious about and really intervene more closely? Should we be shortening the duration of time before we stop seizures and not letting them go as long? It seems as though they have done that at UC Davis – kind of limited the number of seizures that they allow patients to have in the epilepsy monitoring unit.”
Dr. Amy Crepeau
“This study comes back to this issue of who’s at risk for SUDEP, what are the causes for SUDEP, and what are the interventions we can use to try to prevent that or lessen the risk for it,” she added. “We are looking forward to seeing whether these patients have any increased risk of SUDEP that associates with the pulmonary edema.”
Dr. Kennedy and colleagues studied 24 consecutive adult patients, mean age 32, who experienced generalized convulsive seizures while undergoing monitoring in the UC Davis EMU, where all patients with such seizures receive a chest x-ray soon afterward as a safety measure.
Overall, 29% of the patients were found to have pulmonary edema, with or without focal infiltrates, on their chest x-ray, and another 17% were found to have focal infiltrates only.
The mean time elapsed between the seizure and the chest x-ray acquisition was 225 minutes in the patients with abnormal findings and 196 minutes in the patients with normal findings, a nonsignificant difference, reported Dr. Kennedy, who disclosed that he had no relevant conflicts of interest.
The seizure duration was more than twice as long among patients with chest x-ray abnormalities as among counterparts without these abnormalities (250 vs. 101 seconds; P = .002), and the probability of abnormalities increased with seizure duration.
The groups with and without chest x-rays abnormalities did not differ significantly with respect to a variety of demographic and cardiorespiratory and other clinical factors, however.