Clinical cues for detecting ictal asystole

Ghearing, Gena; Munger, Thomas M.; Jaffe, Allan S.; Benarroch, Eduardo E.; Britton, Jeffrey W.

doi:10.1007/s10286-007-0429-9

Cited by 49 publications

(62 citation statements)

References 21 publications

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“…11 This sudden loss of tone was seen in all of our patients. Another series of 16 episodes of ictal asystole noted that 8 episodes demonstrated sudden atonia, 6 were the same as previous seizures, and 2 were associated with generalized tonic-clonic seizures.…”

Section: Discussionsupporting

confidence: 54%

“…6–8 , 12 Another series of 7 ictal asystole patients with falls reported that 6 were fall-free after pacemaker implantation. 11 In a study of 16 ictal bradyarrhythmia patients (10 with seizure-related falls or injuries), 7 became fall-free with either changes in their medications or with epilepsy surgery, 7 patients required a pacemaker to achieve the same results, and 2 patients refused both surgery and pacemaker implantation and continued to have seizures and falls. 5 …”

Section: Discussionmentioning

confidence: 99%

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Ictal Asystole and Ictal Syncope

Bestawros

Darbar

Arain

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background Ictal asystole is a rare, serious, and often treatable cause of syncope. There are currently limited data to guide management. Characterization of ictal syncope predictors may aid in the selection of high-risk patients for treatments such as pacemakers. Methods and Results We searched our epilepsy monitoring unit database from October 2003 through July 2013 for all patients with ictal asystole events. Clinical, EEG, and ECG data for each of their seizures were examined for their relationships with ictal syncope events. In 10 patients with ictal asystole, we observed 76 clinical seizures with 26 ictal asystole episodes, 15 of which led to syncope. No seizure with asystole duration ≤6 seconds led to syncope, while 94% (15/16) of seizures with asystole duration >6 seconds led to syncope (P=0.02). During ictal asystole events, 4 patients had left temporal seizure onset, 4 patients had right temporal seizure onset, and 2 patients had both. Syncope was more common with left temporal (40%) than right temporal seizures (10%; P=0.002). Treatment options included anti-epileptic drug changes, epilepsy surgery, and/or pacemaker implantation. Eight patients received pacemakers. During follow-up of 72±95 months, all patients remained syncope-free. Conclusions Ictal asystole >6 seconds is strongly associated with ictal syncope. Ictal syncope is more common in left than right temporal seizures. A permanent pacemaker should be considered in patients with ictal syncope if they are not considered good candidates for epilepsy surgery.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Ictal Asystole and Ictal Syncope

Bestawros

Darbar

Arain

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…The absence of postictal arrhythmias in our study, despite the recording of thousands of seizures in a high-risk group, suggests that the demonstration of postictal arrhythmias is not sensitive enough to evaluate SUDEP risk. [16][17][18] The first of two previous studies reported that one-fifth of people had a clinically relevant bradycardia or asystole with subsequent permanent pacemaker insertion. Subject 9 was excluded from analysis due to newly diagnosed dissociative seizures.…”

Section: Discussionmentioning

confidence: 99%

The yield of long‐term electrocardiographic recordings in refractory focal epilepsy

et al. 2019

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Objective:To determine the incidence of clinically relevant arrhythmias in refractory focal epilepsy and to assess the potential of postictal arrhythmias as risk markers for sudden unexpected death in epilepsy (SUDEP). Methods: We recruited people with refractory focal epilepsy without signs of ictal asystole and who had at least one focal seizure per month and implanted a loop recorder with 2-year follow-up. The devices automatically record arrhythmias. Subjects and caregivers were instructed to make additional peri-ictal recordings. Clinically relevant arrhythmias were defined as asystole ≥ 6 seconds; atrial fibrillation < 55 beats per minute (bpm), or > 200 bpm and duration > 30 seconds; persistent sinus bradycardia < 40 bpm while awake; and second-or third-degree atrioventricular block and ventricular tachycardia/fibrillation. We performed 12-lead electrocardiography (ECG) and tilt table testing to identify non-seizure-related causes of asystole. Results: We included 49 people and accumulated 1060 months of monitoring. A total of 16 474 seizures were reported, of which 4679 were captured on ECG. No clinically relevant arrhythmias were identified. Three people had a total of 18 shortlasting (<6 seconds) periods of asystole, resulting in an incidence of 2.91 events per 1000 patient-months. None of these coincided with a reported seizure; one was explained by micturition syncope. Other non-clinically relevant arrhythmias included paroxysmal atrial fibrillation (n = 2), supraventricular tachycardia (n = 1), and sinus tachycardia with a right bundle branch block configuration (n = 1). Significance: We found no clinically relevant arrhythmias in people with refractory focal epilepsy during long-term follow-up. The absence of postictal arrhythmias does not support the use of loop recorders in people at high SUDEP risk. K E Y W O R D Scardiac arrhythmias, ECG, epilepsy, implantable loop recorders, sudden unexpected death in epilepsy

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“…Partial or generalized seizures are more likely known to cause tachycardia and only in rare instances, bradycardia or even asystole [2]. Attacks of IA are noted to be clinically characterized by the loss of muscle tone or brief arrhythmic bilateral upper extremity posturing and jerking distinct from but often confused with the rhythmic, tonic-clonic posturing seen typically in epileptic seizures that are not associated with cardiac arrhythmias [3]. There have also been reports with stereotypical prodromes that are associated with IA [4].…”

Section: To the Editormentioning

confidence: 96%