We report two cases of temporo-perisylvian epilepsy with habitual seizures consistently inducible by hyperventilation (HV). One case was non-lesional, while the other was a lesional temporo-perisylvian epilepsy. Both underwent surgical resection and were seizure-free or nearly seizure-free thereafter. We discuss the pathophysiological changes evoked by HV in healthy brains, and those with generalized and focal epilepsy. We provide a comprehensive and critical review of the literature on the role of HV in focal epilepsy. We suggest HV should be considered an activation method for patients with focal epilepsy during epilepsy monitoring unit admissions and may help in the localization of the epileptogenic network/zone.
KawakamiYHirayamaTHashimotoKKuwabaraKFujitaTFujinoO. A case of adversive seizures induced by hyperventilation. J Nippon Med Sch. 2003;70(4):351-354. doi: 10.1272/jnms.70.351. PMID: 12928716.
2.
YangCSChowJCTsaiJJHuangCW. Hyperventilation-induced ictal fear in nonlesional temporal lobe epilepsy. Epilepsy Behav. 2011;21(1):100-102. doi: 10.1016/j.yebeh.2011.02.030. Epub 2011 Apr 8. PMID: 21482194.
3.
MileyCEForsterFM. Activation of partial complex seizures by hyperventilation. Arch Neurol. 1977;34(6):371-373. doi: 10.1001/archneur.1977.00500180065014. PMID: 871260.
MoranoAFanellaMCerulli IrelliE, et al.Seizures in autoimmune encephalitis: findings from an EEG pooled analysis. Seizure. 2020;83:160-168. doi: 10.1016/j.seizure.2020.10.019. Epub 2020 Oct 31. PMID: 33161244.
6.
StefanHBauerJFeistelH, et al.Regional cerebral blood flow during focal seizures of temporal and frontocentral onset. Ann Neurol. 1990;27(2):162-166. doi: 10.1002/ana.410270211. PMID: 2317011.
7.
AlghamdiSAlkhushaimEAlmutairiHAlmarzouqMSerbayaMAlshuremM. A scoping review of protocol and yield of hyperventilation during electroencephalography. Bahrain Med Bullet. 2021;43(2):506-510.
8.
GuaranhaMSBGarzonEBuchpiguelCATazimaSYacubianEMTSakamotoAC. Hyperventilation revisited: physiological effects and efficacy on focal seizure activation in the era of video-EEG monitoring. Epilepsia. 2005;46(1):69-75. https://doi.org/10.1111/j.0013-9580.2005.11104.x
AssenzaGMecarelliOTombiniM, et al.Hyperventilation induces sympathetic overactivation in mesial temporal epilepsy. Epilepsy Res. 2015;110:221-227. https://doi.org/10.1016/j.eplepsyres.2014.12.003
13.
KaneNGrocottLKandlerRLawrenceSPangC. Hyperventilation during electroencephalography: safety and efficacy. Seizure. 2014;23(2):129-134. https://doi.org/10.1016/j.seizure.2013.10.010
14.
BlumeWTDavidRBGomezMR. Generalized sharp and slow wave complexes. Associated clinical features and long-term follow-up. Brain. 1973;96(2):289-306. doi: 10.1093/brain/96.2.289. PMID: 4197585.
15.
PengBDaiJLiJLiangCLiangX. Ictal cerebral haemodynamic characteristics during typical absence seizures, compared to focal seizures with brief alteration of awareness. Epileptic Disord. 2019;21(3):244-251. https://doi.org/10.1684/epd.2019.1067
16.
MarrosuFPulighedduMGiaghedduMCossuGPigaM. Correlation between cerebral perfusion and hyperventilation enhanced focal spiking activity. Epilepsy Res. 2000;40(1):79-86. https://doi.org/10.1016/S0920-1211(00)00111-X
17.
AbubakrAIfeayniIWambacqI. The efficacy of routine hyperventilation for seizure activation during prolonged video-electroencephalography monitoring. J Clin Neurosci. 2010;17(12):1503-1505. https://doi.org/10.1016/j.jocn.2009.12.037
18.
SalvatiKABeenhakkerMP. Out of thin air: hyperventilation-triggered seizures. Brain Res. 2019;1703(December):41-52.
19.
WatembergNFarkashMHar-GilMSezerTGoldberg-SternHAlehanF. Hyperventilation during routine electroencephalography: are three minutes really necessary?Pediatr Neurol. 2015;52(4):410-413. https://doi.org/10.1016/j.pediatrneurol.2014.12.003
SchülerPClausDStefanH. Hyperventilation and transcranial magnetic stimulation: two methods of activation of epileptiform EEG activity in comparison. J Clin Neurophysiol. 1993;10(1):111-115. https://doi.org/10.1097/00004691-199301000-00013
