SEATTLE – Nearly a third of patients who experience a generalized convulsive seizure develop pulmonary edema, suggests a small cohort study reported at the annual meeting of the American Epilepsy Society. The longer the seizure lasts, the higher the probability of this complication.
“There are a few theories about how pulmonary edema can develop” in this context, noted first author Dr. Jeffrey Kennedy of the UC Davis Health System in Sacramento, Calif. Neurogenic mechanisms, hypoxemia, and prolonged negative intrathoracic pressure have all been implicated.
As far as the clinical implications, “postictal pulmonary edema may play a role in the mechanisms of SUDEP (sudden unexpected death in epilepsy),” he proposed at the annual meeting of the American Epilepsy Society.
Session attendee Dr. Kevin Chapman of the child neurology section in the department of pediatrics at Children’s Hospital Colorado, Aurora, asked, “If you identify somebody who has pulmonary edema, what do you do with them?”
“We have been following the patients who are clinically stable,” Dr. Kennedy replied. “We had a patient we identified with Takotsubo cardiomyopathy, which triggered some additional patient care from our cardiology department.”
“I think it just identifies patients who are at higher risk” for poor outcomes, he speculated. “In the EMU [epilepsy monitoring unit], when it comes to letting patients have more seizures, it does make us conservative as far as restarting medications and maybe trying to start giving them some benzodiazepines to try to shut things down.”
Another attendee commented, “Some of my patients’ relatives are very alarmed when the patient suffers severe cyanosis after a seizure. The first thing that our emergency staff will do when they arrive will be to clasp an oxygen mask over them. So our patients ask us, ‘Please, will we provide them with oxygen?’ I have a sneaking suspicion from your data that they may be justified in that. What would you advise?”
Another study done by the UC Davis group looked at a variety of peri-ictal interventions and found simple nursing practices worked about as well as oxygen, according to Dr. Kennedy (Epilepsia 2013;54:377-82). “It seems like just doing something – stimulating the patient, turning them on their side – is enough, rather than just administering oxygen.”