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Effect of hyperventilation on seizure activation: potentiation by antiepileptic drug tapering
  1. Jacques Jonas1,
  2. Jean-Pierre Vignal1,2,
  3. Cédric Baumann3,
  4. Jean-François Anxionnat1,
  5. Mirela Muresan1,
  6. Hervé Vespignani1,2,4,
  7. Louis Maillard1,2
  1. 1Service de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
  2. 2CRAN, UMR 7039, CNRS, Nancy University, Nancy, France
  3. 3Centre d'épidémiologie clinique INSERM CIE6, CHU Nancy, Nancy, France
  4. 4Faculté de Médecine, Université de Nancy, Nancy, France
  1. Correspondence to Dr Louis Maillard, Service de Neurologie, Centre Hospitalier Universitaire de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, Nancy 54035, France; l.maillard{at}


Objective To determine prospectively the efficacy of hyperventilation (HV) to activate epileptic seizures and the contribution of antiepileptic drug tapering.

Methods Eighty patients with proven epilepsy and referred for long-term video-EEG monitoring were consecutively enrolled from November 2007 to December 2008. A seizure was considered as ‘activated’ if it occurred during HV or within 5 min after completion. The rate of activated seizures (number of seizures/h) was compared with the rate of spontaneous seizure. The authors finally compared the effect of HV before and during antiepileptic drug (AED) tapering.

Results The authors analysed 247 days of monitoring. Among 52 recorded seizures, 18 were activated by HV. The rate of activated seizure was nine times higher than the rate of control seizures (p=0.001). In the subgroup of patients with no AED tapering, there was no significant activating effect of HV on seizures. In the subgroup undergoing AED tapering, the effect of HV was not significant before (p=0.257) but very significant during AED tapering (p<0.004).

Discussion The findings confirm that hyperventilation is efficient to activate epileptic seizures in epileptic patients referred for long-term video-EEG monitoring and that this activating effect is mainly related to the potentiating effect of AED tapering. Repeated HVs combined with AED tapering increase the rate of recorded seizures and the diagnostic yield of daytime video-EEG monitoring.

  • Epilepsy
  • video-EEG
  • hyperventilation
  • seizure
  • activation
  • antiepileptic drug
  • neurophysiol
  • clinical

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.