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The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures

Psychogenic non-epileptic seizures (PNES) are a common problem in paediatric neurology and psychiatry that can best be understood as atypical responses to threat. Threats activate the body for action by mediating increases in arousal, respiration, and motor readiness. In previous studies, a range of...

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Autores principales: Kozlowska, Kasia, Rampersad, Reena, Cruz, Catherine, Shah, Ubaid, Chudleigh, Catherine, Soe, Samantha, Gill, Deepak, Scher, Stephen, Carrive, Pascal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610228/
https://www.ncbi.nlm.nih.gov/pubmed/28341888
http://dx.doi.org/10.1007/s00787-017-0976-0
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author Kozlowska, Kasia
Rampersad, Reena
Cruz, Catherine
Shah, Ubaid
Chudleigh, Catherine
Soe, Samantha
Gill, Deepak
Scher, Stephen
Carrive, Pascal
author_facet Kozlowska, Kasia
Rampersad, Reena
Cruz, Catherine
Shah, Ubaid
Chudleigh, Catherine
Soe, Samantha
Gill, Deepak
Scher, Stephen
Carrive, Pascal
author_sort Kozlowska, Kasia
collection PubMed
description Psychogenic non-epileptic seizures (PNES) are a common problem in paediatric neurology and psychiatry that can best be understood as atypical responses to threat. Threats activate the body for action by mediating increases in arousal, respiration, and motor readiness. In previous studies, a range of cardiac, endocrine, brain-based, attention-bias, and behavioral measures have been used to demonstrate increases in arousal, vigilance, and motor readiness in patients with PNES. The current study uses respiratory measures to assess both the motor readiness of the respiratory system and the respiratory regulation of CO(2). Baseline respiratory rates during clinical assessment and arterial CO(2) levels during the hyperventilation component of routine video electroencephalogram were documented in 60 children and adolescents referred for treatment of PNES and in 50 controls. Patients showed elevated baseline respiratory rates [t(78) = 3.34, p = .001], with 36/52 (69%) of patients [vs. 11/28 (39%) controls] falling above the 75th percentile (χ (2) = 6.7343; df = 1; p = .009). Twenty-eight (47%) of patients [vs. 4/50 (8%) controls] showed a skewed hyperventilation-challenge profile—baseline PCO(2) <36 mmHg, a trough PCO(2) ≤ 20 mmHg, or a final PCO(2) <36 mmHg after 15 min of recovery—signaling difficulties with CO(2) regulation (χ (2) = 19.77; df = 1; p < .001). Children and adolescents with PNES present in a state of readiness-for-action characterized by high arousal coupled with activation of the respiratory motor system, increases in ventilation, and a hyperventilation-challenge profile shifted downward from homeostatic range. Breathing interventions that target arousal, decrease respiratory rate, and normalize ventilation and arterial CO(2) may help patients shift brain–body state and avert PNES episodes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00787-017-0976-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-56102282017-10-05 The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures Kozlowska, Kasia Rampersad, Reena Cruz, Catherine Shah, Ubaid Chudleigh, Catherine Soe, Samantha Gill, Deepak Scher, Stephen Carrive, Pascal Eur Child Adolesc Psychiatry Original Contribution Psychogenic non-epileptic seizures (PNES) are a common problem in paediatric neurology and psychiatry that can best be understood as atypical responses to threat. Threats activate the body for action by mediating increases in arousal, respiration, and motor readiness. In previous studies, a range of cardiac, endocrine, brain-based, attention-bias, and behavioral measures have been used to demonstrate increases in arousal, vigilance, and motor readiness in patients with PNES. The current study uses respiratory measures to assess both the motor readiness of the respiratory system and the respiratory regulation of CO(2). Baseline respiratory rates during clinical assessment and arterial CO(2) levels during the hyperventilation component of routine video electroencephalogram were documented in 60 children and adolescents referred for treatment of PNES and in 50 controls. Patients showed elevated baseline respiratory rates [t(78) = 3.34, p = .001], with 36/52 (69%) of patients [vs. 11/28 (39%) controls] falling above the 75th percentile (χ (2) = 6.7343; df = 1; p = .009). Twenty-eight (47%) of patients [vs. 4/50 (8%) controls] showed a skewed hyperventilation-challenge profile—baseline PCO(2) <36 mmHg, a trough PCO(2) ≤ 20 mmHg, or a final PCO(2) <36 mmHg after 15 min of recovery—signaling difficulties with CO(2) regulation (χ (2) = 19.77; df = 1; p < .001). Children and adolescents with PNES present in a state of readiness-for-action characterized by high arousal coupled with activation of the respiratory motor system, increases in ventilation, and a hyperventilation-challenge profile shifted downward from homeostatic range. Breathing interventions that target arousal, decrease respiratory rate, and normalize ventilation and arterial CO(2) may help patients shift brain–body state and avert PNES episodes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00787-017-0976-0) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2017-03-24 2017 /pmc/articles/PMC5610228/ /pubmed/28341888 http://dx.doi.org/10.1007/s00787-017-0976-0 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Contribution
Kozlowska, Kasia
Rampersad, Reena
Cruz, Catherine
Shah, Ubaid
Chudleigh, Catherine
Soe, Samantha
Gill, Deepak
Scher, Stephen
Carrive, Pascal
The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures
title The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures
title_full The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures
title_fullStr The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures
title_full_unstemmed The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures
title_short The respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures
title_sort respiratory control of carbon dioxide in children and adolescents referred for treatment of psychogenic non-epileptic seizures
topic Original Contribution
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610228/
https://www.ncbi.nlm.nih.gov/pubmed/28341888
http://dx.doi.org/10.1007/s00787-017-0976-0
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