Seizures, characterized by abnormal electrical activity in the brain, can affect breathing, sometimes with serious consequences. Understanding their impact on the respiratory system and knowing appropriate responses is important for individuals with epilepsy and their caregivers. This article explores the connection between seizures and breathing, including Sudden Unexpected Death in Epilepsy (SUDEP).
Seizures and Respiratory Impact
Seizures can disrupt normal breathing patterns due to their impact on brain control of respiration. During a seizure, particularly a generalized tonic-clonic seizure, the brain’s abnormal electrical activity can interfere with signals to breathing muscles. This interference can manifest as central apnea, where the brain temporarily ceases to send breathing commands, or obstructive apnea, caused by muscle stiffness or relaxation that blocks the airway.
In a tonic-clonic seizure, the tonic phase involves muscle stiffening, including the chest muscles. This can lead to temporary cessation of breathing and a bluish tint to the skin. Following the seizure, during the postictal phase, breathing difficulties can persist, ranging from shallow or slow breathing to hyperventilation. These irregularities can lead to an imbalance of oxygen and carbon dioxide in the body. Generalized tonic-clonic seizures are particularly associated with significant breathing disruptions.
Understanding SUDEP
Sudden Unexpected Death in Epilepsy (SUDEP) is a rare but serious concern where a person with epilepsy dies suddenly and unexpectedly, with no other cause of death found during post-mortem examination. It often occurs during or immediately after a seizure, frequently during sleep. While the exact cause is not fully understood, research suggests a link to seizure-induced breathing cessation (apnea) and cardiac arrest. Post-seizure brain dysfunction may also contribute to the failure of heart and breathing functions.
SUDEP is estimated to affect about 1 in 1,000 people with epilepsy each year. Several factors can increase the likelihood of SUDEP. Frequent generalized tonic-clonic seizures are a primary risk factor, particularly if they occur at night. Not taking prescribed anti-seizure medications consistently also increases risk, as this can lead to more frequent seizures. Other factors include seizures that began at a young age, living with epilepsy for many years, and certain genetic predispositions.
Responding to Breathing Concerns During a Seizure
When someone experiences a seizure and appears to have breathing difficulties, immediate actions can help ensure their safety. Gently ease them onto one side into the recovery position, with their mouth pointing downwards. This position helps prevent choking on saliva or vomit and keeps the airway clear. Loosen any tight clothing around their neck, such as a tie or collar, to aid breathing.
Avoid putting anything into the person’s mouth, as this can cause injury to their teeth or jaw; a person cannot swallow their tongue. Do not attempt to hold the person down or restrain their movements. While it may appear the person has stopped breathing during a tonic-clonic seizure, they typically resume breathing on their own once the seizure subsides.
Emergency services should be called if:
The seizure lasts longer than 5 minutes.
One seizure quickly follows another without the person regaining consciousness.
Breathing difficulties persist after the seizure.
It is the person’s first seizure.
Reducing Risks and Seeking Medical Guidance
Managing epilepsy effectively is important for reducing seizure-related risks, including breathing problems and SUDEP. Adherence to prescribed anti-seizure medications is a primary strategy. Consistently taking medication as directed helps control seizure frequency and severity, which directly impacts overall risk. Studies indicate that declining medication adherence can significantly increase the risk of SUDEP.
Lifestyle factors also play a role in seizure control. Getting adequate sleep is important, as sleep deprivation can be a common seizure trigger. Managing stress and avoiding excessive alcohol consumption or illicit drug use can contribute to better seizure management.
Regular medical follow-ups with a neurologist or healthcare provider are important to review treatment plans and address any concerns. Individuals with epilepsy and their families should discuss their specific risks, including breathing issues during seizures or SUDEP, with their healthcare team to develop a personalized management strategy.