{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:10:51Z","timestamp":1792480251584,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,1,16]],"date-time":"2018-01-16T00:00:00Z","timestamp":1516060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01\u2010NS090405"],"award-info":[{"award-number":["U01\u2010NS090405"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01\u2010NS090407"],"award-info":[{"award-number":["U01\u2010NS090407"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UO1\u2010NS090415"],"award-info":[{"award-number":["UO1\u2010NS090415"]}],"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":[[2018,3]]},"abstract":"Summary<\/jats:title>Objective<\/jats:title>The aim of this study was to investigate periictal central apnea as a seizure semiological feature, its localizing value, and possible relationship with sudden unexpected death in epilepsy (SUDEP<\/jats:styled-content>) pathomechanisms.<\/jats:p><\/jats:sec>Methods<\/jats:title>We prospectively studied polygraphic physiological responses, including inductance plethysmography, peripheral capillary oxygen saturation (SpO2<\/jats:sub>), electrocardiography, and video electroencephalography (VEEG<\/jats:styled-content>) in 473 patients in a multicenter study of SUDEP<\/jats:styled-content>. Seizures were classified according to the International League Against Epilepsy (ILAE)<\/jats:styled-content> 2017 seizure classification based on the most prominent clinical signs during VEEG<\/jats:styled-content>. The putative epileptogenic zone was defined based on clinical history, seizure semiology, neuroimaging, and EEG<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>Complete datasets were available in 126 patients in 312 seizures. Ictal central apnea (ICA<\/jats:styled-content>) occurred exclusively in focal epilepsy (51\/109 patients [47%] and 103\/312 seizures [36.5%]) (P\u00a0<\/jats:italic><\u00a0.001). ICA<\/jats:styled-content> was the only clinical manifestation in 16\/103 (16.5%) seizures, and preceded EEG<\/jats:styled-content> seizure onset by 8\u00a0\u00b1\u00a04.9\u00a0s, in 56\/103 (54.3%) seizures. ICA<\/jats:styled-content> \u226560\u00a0s was associated with severe hypoxemia (SpO2<\/jats:sub> <75%). Focal onset impaired awareness (FOIA<\/jats:styled-content>) motor onset with automatisms and FOA<\/jats:styled-content> nonmotor onset semiologies were associated with ICA<\/jats:styled-content> presence (P<\/jats:italic>\u00a0<\u00a0.001), ICA<\/jats:styled-content> duration (P<\/jats:italic>\u00a0=\u00a0.002), and moderate\/severe hypoxemia (P<\/jats:italic>\u00a0=\u00a0.04). Temporal lobe epilepsy was highly associated with ICA<\/jats:styled-content> in comparison to extratemporal epilepsy (P<\/jats:italic>\u00a0=\u00a0.001) and frontal lobe epilepsy (P<\/jats:italic>\u00a0=\u00a0.001). Isolated postictal central apnea was not seen; in 3\/103 seizures (3%), ICA<\/jats:styled-content> persisted into the postictal period.<\/jats:p><\/jats:sec>Significance<\/jats:title>ICA<\/jats:styled-content> is a frequent, self\u2010limiting semiological feature of focal epilepsy, often starting before surface EEG<\/jats:styled-content> onset, and may be the only clinical manifestation of focal seizures. However, prolonged ICA<\/jats:styled-content> (\u226560\u00a0s) is associated with severe hypoxemia and may be a potential SUDEP<\/jats:styled-content> biomarker. ICA<\/jats:styled-content> is more frequently seen in temporal than extratemporal seizures, and in typical temporal seizure semiologies. ICA<\/jats:styled-content> rarely persists after seizure end. ICA<\/jats:styled-content> agnosia is typical, and thus it<\/jats:styled-content> may remain unrecognized without polygraphic measurements that include breathing parameters.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.14006","type":"journal-article","created":{"date-parts":[[2018,1,16]],"date-time":"2018-01-16T09:32:38Z","timestamp":1516095158000},"page":"573-582","source":"Crossref","is-referenced-by-count":158,"title":["The incidence and significance of periictal apnea in epileptic seizures"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6067-7414","authenticated-orcid":false,"given":"Nuria","family":"Lacuey","sequence":"first","affiliation":[{"name":"Epilepsy Center University Hospitals Cleveland Medical Center Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Zonjy","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnson P.","family":"Hampson","sequence":"additional","affiliation":[{"name":"Epilepsy Center University Hospitals Cleveland Medical Center Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. R. Sandhya","family":"Rani","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Zaremba","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rup K.","family":"Sainju","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"University of Iowa School of Medicine Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian K.","family":"Gehlbach","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"University of Iowa School of Medicine Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Schuele","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"Feinberg School of Medicine Northwestern University Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1068-1797","authenticated-orcid":false,"given":"Daniel","family":"Friedman","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"NYU Langone School of Medicine New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orrin","family":"Devinsky","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"NYU Langone School of Medicine New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maromi","family":"Nei","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"Sidney Kimmel Medical College Thomas Jefferson University Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald M.","family":"Harper","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"Department of Neurobiology and the Brain Research Institute University of California Los Angeles (UCLA) Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Allen","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"Institute of Neurology University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate","family":"Diehl","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"Institute of Neurology University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0798-0131","authenticated-orcid":false,"given":"John J.","family":"Millichap","sequence":"additional","affiliation":[{"name":"NINDS Center for SUDEP Research (CSR) Cleveland OH USA"},{"name":"Ann & Robert H. 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