{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:21:31Z","timestamp":1786371691407,"version":"build-2736575974"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Sudden unexpected death in epilepsy (SUDEP) is a devastating consequence of some generalized convulsive seizures (GCS). Recent work has focused on seizure related apnea as a biomarker of SUDEP risk, frequently without characterizing the adequacy of non\u2010apneic ventilation or identifying other dysfunctional breathing patterns. We hypothesized that GCS frequently induce immediate, severe, non\u2010apneic respiratory dysfunction that can induce critical hypoxia and bradycardia and sought to characterize breathing patterns after GCS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Adult patients admitted to an epilepsy monitoring unit were studied. The effects of GCS on breathing and heart rate were analyzed using nasal pressure transducers, chest and abdominal respiratory inductance plethysmography, capillary oxygen saturation, transcutaneous CO\n                      <jats:sub>2<\/jats:sub>\n                      , electrocardiogram, electroencephalogram, and expert audiovisual analysis. Correlation analyses, the Mann\u2013Whitney test, and an unpaired\n                      <jats:italic>t<\/jats:italic>\n                      test were used to analyze relationships between dysfunctional breathing patterns and both the severity of postictal hypoxemia and the heart rate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010two GCS from 22 patients were analyzed and 31 exhibited 1 or more of the following breathing patterns: disordered rhythmicity (n\u2009=\u200928\/32, 87.5%), shallow breathing (n\u2009=\u200912\/32, 37.5%), thoracoabdominal asynchrony (n\u2009=\u200924\/30, 80.0%), and upper airway obstruction (n\u2009=\u200930\/32, 93.8%). Oxygen desaturation was more severe when postictal breathing was shallow or irregular in amplitude. The latter was associated with absolute or relative bradycardia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Nonfatal GCS frequently induce immediate, severe, non\u2010apneic respiratory dysfunction temporally associated with severe hypoxia and bradycardia. Our study suggests that postictal respiratory and cardiac function are tightly coupled and highlights the importance of including all the relevant pathologic variables in studies of SUDEP pathogenesis. 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