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Peer-reviewedCC BY-NC-NDClinical neurophysiology practice

Diaphragm 'atonia' during ictal and post-ictal apnoea: A case report.

  • Margherita Burani1,2
  • Giada Giovannini2
  • Niccolò Orlandi1,2
  • Matteo Pugnaghi2
  • Lisa Taruffi1,2
  • Sofia Angeloni1,2
  • Stefano Meletti3
  1. 1Department of Biomedical Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.
  2. 2Neurophysiology Unit and Epilepsy Centre, Neuroscience Department, Modena AOU, Modena, Italy.
  3. 3Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Abstract

Objective

Ictal and post ictal central apnoea (ICA and PCA) are driven by suppression of brainstem respiratory drive and represent an electroclinical biomarker of sudden unexpected death in epilepsy (SUDEP). While animal models have demonstrated a true 'atonic diaphragm' underlying seizure-related apnoea, no human polygraphic study has yet confirmed respiratory muscle 'atonia' with direct EMG recording.Methods

In this case report, we present a 26-year-old female with meningoencephalocele-associated temporal lobe epilepsy who underwent a video-EEG polygraphy integrated with surface EMG from intercostals muscles and the diaphragm.Results

We recorded a left frontotemporal seizure with ICA and four consecutives PCA events, all accompanied by surface electromyographic silence of the diaphragm and the intercostal muscles.Conclusions

This case provide a human polygraphic evidence of diaphragm and intercostal muscles silence during ICA and PCA, confirming the cascade of respiratory inhibition through brainstem respiratory centres down to respiratory muscles themselves. Notably, muscles relaxation occurred despite the patient was awake and able to follow commands.Significance

These findings support the importance of cardiorespiratory polygraphy during presurgical video-EEG evaluation, especially for temporal lobe seizures, to identify patients at higher SUDEP risk.

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Cite

BibTeXRIS
BibTeX
@article{burani2026diaphragm,
  title = {{Diaphragm 'atonia' during ictal and post-ictal apnoea: A case report.}},
  author = {Margherita Burani and Giada Giovannini and Niccolò Orlandi and Matteo Pugnaghi and Lisa Taruffi and Sofia Angeloni and Stefano Meletti},
  journal = {Clinical neurophysiology practice},
  year = {2026},
  month = oct,
  doi = {10.1016/j.cnp.2026.10.004},
  url = {https://europepmc.org/article/MED/42904215},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Diaphragm 'atonia' during ictal and post-ictal apnoea: A case report.
AU  - Margherita Burani
AU  - Giada Giovannini
AU  - Niccolò Orlandi
AU  - Matteo Pugnaghi
AU  - Lisa Taruffi
AU  - Sofia Angeloni
AU  - Stefano Meletti
PY  - 2026
DA  - 2026/10/11
JO  - Clinical neurophysiology practice
DO  - 10.1016/j.cnp.2026.10.004
UR  - https://europepmc.org/article/MED/42904215
AB  - Objective  Ictal and post ictal central apnoea (ICA and PCA) are driven by suppression of brainstem respiratory drive and represent an electroclinical biomarker of sudden unexpected death in epilepsy (SUDEP). While animal models have demonstrated a true 'atonic diaphragm' underlying seizure-related apnoea, no human polygraphic study has yet confirmed respiratory muscle 'atonia' with direct EMG recording.Methods  In this case report, we present a 26-year-old female with meningoencephalocele-associated temporal lobe epilepsy who underwent a video-EEG polygraphy integrated with surface EMG from intercostals muscles and the diaphragm.Results  We recorded a left frontotemporal seizure with ICA and four consecutives PCA events, all accompanied by surface electromyographic silence of the diaphragm and the intercostal muscles.Conclusions  This case provide a human polygraphic evidence of diaphragm and intercostal muscles silence during ICA and PCA, confirming the cascade of respiratory inhibition through brainstem respiratory centres down to respiratory muscles themselves. Notably, muscles relaxation occurred despite the patient was awake and able to follow commands.Significance  These findings support the importance of cardiorespiratory polygraphy during presurgical video-EEG evaluation, especially for temporal lobe seizures, to identify patients at higher SUDEP risk.
SN  - 2467-981X
ER  -