We sincerely thank Dr. Yücel for the interest in our case report and for the insightful comments provided. We are grateful for the opportunity to further clarify and expand upon several important points raised. As highlighted by Dr. Yücel, ictal central apnea (ICA) holds significant value in localizing seizure onset, particularly to the mesial temporal lobe,1 and both prolonged ICA and prolonged postictal central apnea (PICA) are associated with an increased risk of sudden unexpected death in epilepsy (SUDEP).2 We fully agree that recognizing these respiratory phenomena is critical in both diagnostic and prognostic contexts. In our epilepsy monitoring unit (EMU), we have implemented a standardized protocol3 that incorporates respiratory inductance plethysmography using thoraco-abdominal breathing belts alongside the conventional continuous pulse oximetry. This approach is highly valuable, not only in enhancing seizure localization during presurgical evaluation, but also in identifying patients who may be at increased risk for SUDEP, thereby enabling closer monitoring and tailored management strategies. Importantly, our experience suggests that without the use of thoraco-abdominal belts, prolonged ICA and PICA may go undetected in a substantial number of patients. Furthermore, as demonstrated in our reported case, ICA may occasionally represent the only observable seizure semiology, reinforcing the importance of respiratory monitoring in the EMU. Based on these observations, we strongly advocate for the broader adoption of respiratory belts in EMU settings. We believe that integrating this modality into routine practice can significantly improve both diagnostic accuracy and SUDEP risk stratification. No funding is applicable to this article. The authors declare no conflict of interest. Data sharing is not applicable to this article.
Zhao et al. (Fri,) studied this question.