Ictal asystole with convulsive syncope mimicking secondary generalisation: a depth electrode study

Rossetti, Andrea O.; Dworetzky, Barbara A.; Madsen, Joseph R.; Golub, O; Beckman, Joshua A.; Bromfield, Edward B

doi:10.1136/jnnp.2004.051839

Cited by 48 publications

(36 citation statements)

References 19 publications

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“…Among individuals with ictal asystole reported in the literature, five (including the individual reported in our study) had bilateral intracranial recordings [8][9][10][11] . The localisation of the epileptic focus was respectively temporal (left in two, not specified in one), left orbito-frontal, and right frontoneotemporal.…”

Section: Discussionmentioning

confidence: 99%

“…The localisation of the epileptic focus was respectively temporal (left in two, not specified in one), left orbito-frontal, and right frontoneotemporal. Interestingly, in four of these cases, the onset of asystole was associated with diffusion of the epileptic discharges in the contralateral homologous regions [8][9][10] . Asystole may thus result from a particular propagation pattern implicating subcortical autonomic structures.…”

Section: Discussionmentioning

confidence: 99%

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Potentially Life-Threatening Ictal Bradycardia in Intractable Epilepsy

Odier

Nguyen²,

Bouthillier³

et al. 2009

Can. j. neurol. sci.

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The incidence of sudden unexpected death in epilepsy (SUDEP) is up to 1/200 patients-years in adults with refractory epilepsy 1 . Among the potential mechanisms underlying SUDEP, cardiac dysrhythmia and central apnoea have been proposed 2 . Various ictal arrhythmias have been described. The most frequent is tachycardia 3,4 . In turn, ictal bradycardia (IB) is generally believed to be rare 2,4 . The reported prevalence varies according to bradycardia definition 2,4,5 . However, in a recent prospective study of 19 individuals with intractable seizures, up to 21% exhibited severe bradycardia or asystole requiring permanent pacemaker (PM) 3 . The incidence of bradycardia among all recorded seizures was approximately 2%, suggesting that individuals exhibit severe IB in only a small percentage of their seizures 3 . In the present study, we intended to estimate the prevalence of IB in our population of intractable epilepsy, and ABSTRACT: Background: Recently a high prevalence of asystole was found in individuals with refractory epilepsy. Objective: To measure the prevalence and characterize the pattern of ictal bradycardia (IB) in our cohort. Method: We analyzed ictal heart rate (HR) and seizure localization in 69 consecutive individuals with intractable epilepsy. Ictal bradycardia was defined by HR less than 60 beat per min (bpm) and a fall of more than 30 bpm. Results: Ictal bradycardia was observed in 1.9% of seizures and in five individuals (7.2%), who presented IB in 5.7% of their seizures. Four of them had also relative IB (a decrease of HR of more than10 bpm) in the majority of their seizures. Four additional individuals showed relative IB. Conclusion: Ictal bradycardia occurs more frequently than previously thought in individuals with refractory epilepsy. Recognition of individuals with small to moderate ictal HR decrease may help to identify those at greatest risk for asystole. Résultats : Une BI a été notée au cours de 1,9% des crises et chez 5 individus (7,2%), qui présentaient une BI au cours de 5,7% de leurs crises. Quatre d'entre eux avaient également une BI relative (une diminution de la FC de plus de 10 bpm) au cours de la majorité de leurs crises. Quatre autres individus présentaient une BI relative. Conclusion: La BI survient plus souvent qu'on ne le pensait chez les patients atteints d'épilepsie réfractaire au traitement. L'identification des patients qui présentent une diminution de la FC de légère à modérée pourrait aider à identifier ceux dont le risque d'asystolie est le plus élevé.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Potentially Life-Threatening Ictal Bradycardia in Intractable Epilepsy

Odier

Nguyen²,

Bouthillier³

et al. 2009

Can. j. neurol. sci.

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“…7,9,10 Localization for a cardiac depressor area has been proposed to be the anterior cingulate cortex of the frontal lobe, the insular region, or the nucleus ambiguus and may require bilateral mesial temporal region activation. 7,[11][12][13] Indeed, left insular stimulation has been shown to produce cardiac depressor effects. 10 This finding led to the suggestion that cardiac parasympathetic function lateralizes to the left insular region, and cardiac sympathetic function lateralizes to the right insular region.…”

Section: Discussionmentioning

confidence: 99%

Ictal Asystole in Focal Epilepsy

Newey

Sarwal

2015

The Neurohospitalist

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Ictal bradyarrhythmias are rare episodes occurring in patients with or without a past cardiac history. These episodes go unnoticed unless the patient is monitored on simultaneous video-electroencephalogram and 1-lead electrocardiogram. Recognizing ictal bradyarrhythmias is important, since episodes may predispose patients to sudden, unexplained death in epilepsy. We present 2 cases of ictal asystole in patients with right temporal lobe epilepsy. The first patient had seizures refractory to medical therapy and received a pacemaker. The seizures in the second patient responded well to antiepileptic medication, and a pacemaker was deferred. These cases highlight the differing cardiovascular treatment options for ictal asystole.

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“…A parasympathetic-mediated pathway that involves the limbic system is possible the way bradyarrhythmia occur and may be implicated for the mechanism of SUDEP (Leung et al, 2007). Data from intracranial EEG records demonstrated that bradyarrhythmic episodes were mostly associated with temporal lobe seizures, nevertheless, seizure involvement of insular cortex or cingulated cortex could not be excluded (Altenmüller et al 2004, Devinsky et al 1997Rossetti et al 2005;Kahane et al 1999). Also, some studies suggest amygdala central nucleus damage may contribute to SUDEP considering that his structure can play a role in respiratory timing (Nashef et al, 1996;Stollberger & Finsterer, 2004;Ryvlin et al, 2006;So, 2008;.…”

Section: Brain Mechanisms Involved In Sudepmentioning

confidence: 99%