ObjectiveIctal central apnea (ICA) is a semiological sign of focal epilepsy, associated with temporal and frontal lobe seizures. In this study, using qualitative and quantitative approaches, we aimed to assess the localizational value of ICA. We also aimed to compare ICA clinical utility in relation to other seizure semiological features of focal epilepsy.MethodsWe analyzed seizures in patients with medically refractory focal epilepsy undergoing intracranial stereotactic electroencephalographic (SEEG) evaluations with simultaneous multimodal cardiorespiratory monitoring. A total of 179 seizures in 72 patients with reliable artifact‐free respiratory signal were analyzed.ResultsICA was seen in 55 of 179 (30.7%) seizures. Presence of ICA predicted a mesial temporal seizure onset compared to those without ICA (odds ratio = 3.8, 95% confidence interval = 1.3–11.6, p = 0.01). ICA specificity was 0.82. ICA onset was correlated with increased high‐frequency broadband gamma (60–150Hz) activity in specific mesial or basal temporal regions, including amygdala, hippocampus, and fusiform and lingual gyri. Based on our results, ICA has an almost 4‐fold greater association with mesial temporal seizure onset zones compared to those without ICA and is highly specific for mesial temporal seizure onset zones. As evidence of symptomatogenic areas, onset‐synchronous increase in high gamma activity in mesial or basal temporal structures was seen in early onset ICA, likely representing anatomical substrates for ICA generation.InterpretationICA recognition may help anatomoelectroclinical localization of clinical seizure onset to specific mesial and basal temporal brain regions, and the inclusion of these regions in SEEG evaluations may help accurately pinpoint seizure onset zones for resection. ANN NEUROL 2024

中文翻译：

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发作性中枢性呼吸暂停可预测内侧颞叶癫痫发作：一项颅内调查

目的 发作性中枢性呼吸暂停 (ICA) 是局灶性癫痫的症状学体征，与颞叶和额叶癫痫发作相关。在本研究中，我们使用定性和定量方法来评估 ICA 的本地化价值。我们还旨在比较 ICA 与局灶性癫痫其他癫痫发作症状学特征相关的临床效用。方法我们分析了接受颅内立体定向脑电图 (SEEG) 评估和同步多模式心肺监测的难治性局灶性癫痫患者的癫痫发作。对 72 名具有可靠的无伪影呼吸信号的患者总共 179 次癫痫发作进行了分析。结果 179 例癫痫发作中，有 55 例 (30.7%) 出现 ICA。与无 ICA 的患者相比，存在 ICA 的患者可预测内侧颞叶癫痫发作（比值比 = 3.8，95% 置信区间 = 1.3–11.6，p= 0.01）。ICA 特异性为 0.82。ICA 的发作与特定内侧或基底颞区（包括杏仁核、海马体、梭状回和舌回）高频宽带伽玛（60-150Hz）活动的增加相关。根据我们的结果，与没有 ICA 的患者相比，ICA 与内侧颞叶癫痫发作区的关联性高出近 4 倍，并且对于内侧颞叶癫痫发作区具有高度特异性。作为症状发生区域的证据，在早期发作的 ICA 中观察到内侧或基底颞结构中高伽马活性的发作同步增加，可能代表 ICA 生成的解剖学基础。解释 ICA 识别可能有助于临床癫痫发作对特定内侧和基底的解剖电临床定位颞脑区域，并将这些区域纳入 SEEG 评估可能有助于准确确定癫痫发作区域以进行切除。安神经学 2024