• Nuria Lacuey, Rita Martins, Laura Vilella, Johnson P Hampson, M R Sandhya Rani, Kingman Strohl, Anita Zaremba, Jaison S Hampson, Rup K Sainju, Daniel Friedman, Maromi Nei, Catherine Scott, Brian K Gehlbach, Norma J Hupp, Stephan Schuele, Jennifer Ogren, Ronald M Harper, Luke Allen, Beate Diehl, Lisa M Bateman, Orrin Devinsky, George B Richerson, and Samden Lhatoo.
• Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address: nurialacuey@yahoo.es.
• Epilepsy Behav. 2019 Sep 1; 98 (Pt A): 73-79.

ObjectiveIctal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy.MethodsPatients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group.ResultsFour hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05).ConclusionsSeizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.Copyright © 2019 Elsevier Inc. All rights reserved.

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