Pearls & Oy-sters: Severe Case of Ictal Asystole in Temporal Lobe Epilepsy

Abstract

Ictal asystole is a rare condition associated primarily with temporal lobe epilepsy that can cause syncope, falls and head trauma. It is also associated with increased rates of sudden unexplained death in epilepsy (SUDEP). We present a case of a 33-year-old woman with a history of childhood epilepsy who presented with 3 years of recurrent syncope. Video-EEG revealed temporal lobe seizures with ictal asystole. EKG showed stepwise progression of bradycardia, asystole, and tachycardia. MRI showed focal cortical thickening at the right insular cortex with blurring of the grey-white matter interface, consistent with insular focal cortical dysplasia. The patient was transitioned from lacosamide to clobazam due to concern for PR interval prolongation and was referred to cardiology for pacemaker placement. Ictal asystole should be considered as a rare but serious cause of unexplained recurrent syncope, particularly in patients with a history of seizures. Management includes antiepileptic drug regimen optimization, consideration of epilepsy surgery, and referral for cardiac pacing when asystole lasts greater than 6 seconds.

Attacks With Urinary Incontinence Without Convulsions: Complete Atrioventricular Block Mimicking an Epileptic Seizure

“…While it remains theoretically possible that cardiac arrest could occur during epileptic seizures associated with temporal lobe epilepsy (ictal asystole) [8], it is noteworthy that all events in the present case were resolved through pacemaker implantation without the need for anti-seizure medication. Therefore, it is imperative to underscore the importance of avoiding overdiagnosis of epilepsy solely on the grounds of unspecific EEG abnormalities such as focal slows.…”

Energy Dynamics in Seizure Disorder: Reexamining the Sacred Disease

“…Cardiovascular involvement during seizures is very common [239][240][241][242][243][244][245][246][247]. A rash of cardiac rhythmic disturbances, seen in up to 60-80% of seizures, have been described including tachycardias, bradycardias, asystole, A-V conduction blocks, as well as atrial and ventricular fibrillation.…”