{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T10:40:51Z","timestamp":1789814451239,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T00:00:00Z","timestamp":1452729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1 TR000002"],"award-info":[{"award-number":["UL1 TR000002"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The pathophysiology of sudden unexpected death in epilepsy (<jats:styled-content style=\"fixed-case\">SUDEP<\/jats:styled-content>) remains undetermined. Seizures are accompanied by respiratory dysfunction (<jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>). Postictal generalized electroencephalography (<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>) suppression (<jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content>) may follow generalized tonic\u2013clonic seizures (<jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content>). Following <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> patients have impaired arousal and may be motionless. Patients with <jats:styled-content style=\"fixed-case\">SUDEP<\/jats:styled-content> are usually prone. Postictal immobility (PI) may contribute to <jats:styled-content style=\"fixed-case\">SUDEP<\/jats:styled-content> by not permitting repositioning of the head to allow unimpeded ventilation. To determine whether <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content> and\/or ictal characteristics are associated with <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>, we analyzed patients with <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> in the epilepsy monitoring unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We investigated for associations between <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> duration and <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content>, ictal\/postictal oxygen saturation (SpO<jats:sub>2<\/jats:sub>), end\u2010tidal <jats:styled-content style=\"fixed-case\">CO<\/jats:styled-content><jats:sub>2<\/jats:sub> (<jats:styled-content style=\"fixed-case\">ETCO<\/jats:styled-content><jats:sub>2<\/jats:sub>), seizure localization, duration, and tonic and total convulsive phase duration. We investigated for linkage between <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> and these measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy patients with 181 <jats:styled-content style=\"fixed-case\">GTCS<\/jats:styled-content> and available SpO<jats:sub>2<\/jats:sub> and\/or <jats:styled-content style=\"fixed-case\">ETCO<\/jats:styled-content><jats:sub>2<\/jats:sub> data were studied. Simple linear regression analysis by seizures showed that <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> duration was associated with peak periictal <jats:styled-content style=\"fixed-case\">ETCO<\/jats:styled-content><jats:sub>2<\/jats:sub> (p\u00a0=\u00a00.03), duration of oxygen desaturation (p\u00a0=\u00a00.005) and with SpO<jats:sub>2<\/jats:sub> nadir (p\u00a0=\u00a00.02). <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> duration was not associated with tonic, convulsive phase or total seizure duration. Analysis by patients also showed significant association of <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>. Duration of <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> was longer following seizures with <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> (p\u00a0&lt;\u00a00.001). <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> was not associated with the tonic, convulsive phase or total seizure duration. SpO<jats:sub>2<\/jats:sub> nadir was lower in seizures with <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> (p\u00a0=\u00a00.046), <jats:styled-content style=\"fixed-case\">ETCO<\/jats:styled-content><jats:sub>2<\/jats:sub> peak change (p\u00a0=\u00a00.003) was higher, and duration of <jats:styled-content style=\"fixed-case\">ETCO<\/jats:styled-content><jats:sub>2<\/jats:sub> elevation (p\u00a0=\u00a00.03) was longer. Multivariable regression analysis showed that <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> and severe <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content> were associated with <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> duration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>The duration of <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> and presence of <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content> are associated with periictal <jats:styled-content style=\"fixed-case\">RD<\/jats:styled-content>. The duration of <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> is also associated with the presence of <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content>. Seizure duration or duration of the convulsive phase is not associated with <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">PGES<\/jats:styled-content>. Interventions aimed at reversing impaired arousal and <jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content> may reduce <jats:styled-content style=\"fixed-case\">SUDEP<\/jats:styled-content> risk.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.13312","type":"journal-article","created":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T16:28:13Z","timestamp":1452788893000},"page":"412-417","source":"Crossref","is-referenced-by-count":74,"title":["Postictal immobility and generalized <scp>EEG<\/scp> suppression are associated with the severity of respiratory dysfunction"],"prefix":"10.1111","volume":"57","author":[{"given":"Jonathan","family":"Kuo","sequence":"first","affiliation":[{"name":"Department of Neurology University of California Davis California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjie","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Statistics University of California Davis California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin\u2010Shang","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Biostatistics Department of Public Health Sciences University of California Davis California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California Davis California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masud","family":"Seyal","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California Davis California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,1,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.60.3.297"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awn277"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02490.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.2000.tb00206.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1996.tb12112.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70214-X"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2011.04.008"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2011.03296.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2012.03443.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22101"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12094"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02518.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001260"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2012.03691.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2011.03296.x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001949"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/82.2.162"},{"key":"e_1_2_8_19_1","volume-title":"Epilepsy and other chronic convulsive diseases","author":"Gowers WR","year":"1881"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.64"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12021"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2015.02.023"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2014.12.058"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2015.01.023"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12872"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000156352.61328.CB"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13117"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fepi.13312","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.13312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T09:17:20Z","timestamp":1695547040000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/epi.13312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1,14]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,3]]}},"alternative-id":["10.1111\/epi.13312"],"URL":"https:\/\/doi.org\/10.1111\/epi.13312","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1,14]]}}}