Advertisement

New-onset seizure at high altitude among healthy males

      Highlights

      • For subjects living at sea level, exposure to high altitudes for a short period is associated with an increased risk of new-onset seizures.
      • The risk of new-onset seizures increases with increasing altitudes from 2500 m to >5800 m.
      • A specific etiology may not be ascertainable in most cases of seizures at high-altitude, but it is important to stay vigilant about excluding cerebral venous thrombosis.

      Abstract

      Objectives

      The risk of developing new-onset seizure following ascent to high-altitude areas is currently unknown. We undertook a prospective study to quantify this risk.

      Methods

      The study was conducted at a tertiary care hospital in India between July 2015 and December 2017. It included apparently healthy males of age ≥18 years who ascended to an altitude of ≥ 2500 m and stayed there for > 30 continuous days. Individuals with a history of seizure in the past two years, those who had not undergone acclimatization protocol, and those who had a history of any chronic systemic illness were excluded.

      Results

      The 39,213 individuals included in the study together had 39,848.6 person-years of high-altitude exposure. New-onset seizure after ascent occurred in 41 of them, indicating a seizure incidence rate of 102.9 per 100,000 person-years (95% CI = 75.8–139.7). The incidence per 100,000 person-years (95% CI) at altitudes of 2,500–3,500 m, 3,500–5,800 m, and > 5,800 m was 82.3 (53.6–126.1), 134.6 (84.9–213.6), and 210.8 (52.8–841.4), respectively. Seizure was secondary to cerebral venous thrombosis in 12 (29.3%) individuals. No etiology could be determined in the remaining 29 (70.7%) individuals.

      Conclusions

      Our findings suggest that when subjects living at sea level are exposed to high altitudes, they will be at a higher risk for new-onset seizure in the immediate few months of exposure, and that this risk increases with increasing altitude.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Seizure - European Journal of Epilepsy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hackett P.H.
        • Roach R.C.
        High-altitude illness.
        N Engl J Med. 2001; 345 (Jul 12): 107-114
        • Basnyat B.
        • Murdoch D.R.
        High-altitude illness.
        Lancet. 2003; 361 (Jun 7): 1967-1974
        • Wilson M.H.
        • Newman S.
        • Imray C.H.
        The cerebral effects of ascent to high altitudes.
        Lancet Neurol. 2009; 8 (Feb): 175-191
        • Annegers J.F.
        • Hauser W.A.
        • Lee J.R.
        • Rocca W.A.
        Incidence of acute symptomatic seizures in Rochester.
        Minnesota. 1995; 36 (1935-1984 EpilepsiaApr): 327-333
        • Hauser W.A.
        • Annegers J.F.
        • Kurland L.T.
        Incidence of epilepsy and unprovoked seizures in Rochester.
        Minnesota. 1993; 34 (1935-1984 EpilepsiaMay-Jun): 453-468
        • Huff J.S.
        • Morris D.L.
        • Kothari R.U.
        • Gibbs M.A.
        Emergency Medicine Seizure Study G. Emergency department management of patients with seizures: a multicenter study.
        Acad Emerg Med. 2001; 8 (Jun): 622-628
        • Goel D.
        • Aggarwal P.
        • Kandpal S.D.
        • Kakkar R.
        • Negi D.
        • Mittal N.
        Epidemiology of new onset seizures and epilepsy cases: a prospective cohort study.
        Int J Epileps. 2020; 6: 30-38
      1. Saha S.P., Bhattachrya S., Roy B.K., Basu A., Maity A., Das S.K. A prospective incidence study of epilepsy in a rural community of West-Bengal, India. 2008.

        • Mani K.S.
        • Rangan G.
        • Srinivas H.V.
        • Kalyanasundaram S.
        • Narendran S.
        • Reddy A.K.
        The Yelandur study: a community-based approach to epilepsy in rural.
        South India–Epidemiol Aspects Seizure. 1998; 7 (Aug): 281-288
        • Amudhan S.
        • Gururaj G.
        • Satishchandra P.
        Epilepsy in India I: Epidemiology and public health.
        Ann Indian Acad Neurol. 2015; 18 (Jul-Sep): 263-277
        • Jallon P.
        • Goumaz M.
        • Haenggeli C.
        • Morabia A.
        Incidence of first epileptic seizures in the canton of Geneva.
        Switzerland Epilepsia. 1997; 38 (May): 547-552
        • Loiseau J.
        • Loiseau P.
        • Guyot M.
        • Duche B.
        • Dartigues J.F.
        Aublet B. Survey of seizure disorders in the French southwest. I. Incidence of epileptic syndromes.
        Epilepsia. 1990; 31 (Jul-Aug): 391-396
        • Hauser W.A.
        • Beghi E.
        First seizure definitions and worldwide incidence and mortality.
        Epilepsia. 2008; 49 (Suppl 1): 8-12
        • Forsgren L.
        • Bucht G.
        • Eriksson S.
        • Bergmark L.
        Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study.
        Epilepsia. 1996; 37 (Mar): 224-229
        • Hochachka P.W.
        • Clark C.M.
        • Brown W.D.
        • Stanley C.
        • Stone C.K.
        • Nickles R.J.
        • et al.
        The brain at high altitude: hypometabolism as a defense against chronic hypoxia?.
        J Cereb Blood Flow Metab. 1994; 14 (Jul): 671-679
        • Hochachka P.W.
        • Monge C.
        Evolution of human hypoxia tolerance physiology.
        Adv Exp Med Biol. 2000; 475: 25-43
        • Hadolt I.
        • Litscher G.
        Noninvasive assessment of cerebral oxygenation during high altitude trekking in the Nepal Himalayas 2850-5600.
        Neurol Res. 2003; 25 (Mar): 183-188
        • West JBTH
        Ravenhill and his contributions to mountain sickness.
        J Appl Physiol. 1985; 80 (1996 Mar): 715-724
        • Kramer A.F.
        • Coyne J.T.
        • Strayer D.L.
        Cognitive function at high altitude.
        Hum Factors. 1993; 35 (Jun): 329-344
        • Nelson M.
        Psychological testing at high altitudes.
        Aviat Space Environ Med. 1982; 53 (Feb): 122-126
        • Fowler B.
        • Elcombe D.D.
        • Kelso B.
        • Porlier G.
        The threshold for hypoxia effects on perceptual-motor performance.
        Hum Factors. 1987; 29 (Feb): 61-66
        • van Veen J.J.
        • Makris M.
        Altitude and coagulation activation: does going high provoke thrombosis?.
        Acta Haematol. 2008; 119: 156-157
        • Jensen J.B.
        • Wright A.D.
        • Lassen N.A.
        • Harvey T.C.
        • Winterborn M.H.
        • Raichle M.E.
        • et al.
        Cerebral blood flow in acute mountain sickness.
        J Appl Physiol. 1985; 69 (1990 Aug): 430-433
        • Winn H.R.
        • Rubio R.
        • Berne R.M.
        Brain adenosine concentration during hypoxia in rats.
        Am J Physiol. 1981; 241 (Aug): H235-H242
        • Winn H.R.
        • Rubio G.R.
        • Berne R.M.
        The role of adenosine in the regulation of cerebral blood flow.
        J Cereb Blood Flow Metab. 1981; 1: 239-244
        • Sanders D.B.
        • Kelley T.
        • Larson D.
        The role of nitric oxide synthase/nitric oxide in vascular smooth muscle control.
        Perfusion. 2000; 15 (Mar): 97-104
        • Appenzeller O.
        • Claydon V.E.
        • Gulli G.
        • Qualls C.
        • Slessarev M.
        • Zenebe G.
        • et al.
        Cerebral vasodilatation to exogenous NO is a measure of fitness for life at altitude.
        Stroke. 2006; 37 (Jul): 1754-1758
        • Yamakawa M.
        • Liu L.X.
        • Date T.
        • Belanger A.J.
        • Vincent K.A.
        • Akita G.Y.
        • et al.
        Hypoxia-inducible factor-1 mediates activation of cultured vascular endothelial cells by inducing multiple angiogenic factors.
        Circ Res. 2003; 93 (Oct 3): 664-673
        • Schoch H.J.
        • Fischer S.
        • Marti H.H.
        Hypoxia-induced vascular endothelial growth factor expression causes vascular leakage in the brain.
        Brain. 2002; 125 (Nov): 2549-2557
        • Bailey D.M.
        • Roukens R.
        • Knauth M.
        • Kallenberg K.
        • Christ S.
        • Mohr A.
        • et al.
        Free radical-mediated damage to barrier function is not associated with altered brain morphology in high-altitude headache.
        J Cereb Blood Flow Metab. 2006; 26 (Jan): 99-111
        • Bailey D.M.
        Radical dioxygen: from gas to (unpaired!) electrons.
        Adv Exp Med Biol. 2003; 543: 201-221