Potentially Life-Threatening Ictal Bradycardia in Intractable Epilepsy

Odier, Céline; Nguyen, Dang Khoa; Bouthillier, Alain; Giard, N; Saint‐Hilaire, Jean‐Marc; Cossette, Patrick

doi:10.1017/s0317167100006272

Cited by 10 publications

(3 citation statements)

References 12 publications

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“…The brain areas responsible for controlling the autonomic nervous system are the insular cortex, amygdala, cingulate gyrus, prefrontal cortex, hypothalamus and brainstem [10,15,49,50]. These areas are part of a dynamic network and for the generation of IA, a specific pattern of activation of this network must be engaged during a seizure [25,51,52].…”

Section: Discussionmentioning

confidence: 99%

Low‐grade tumour over the left temporal neocortex and ictal asystole: network and surgical implications

Russo¹,

Francione²,

Martinoni³

et al. 2021

Epileptic Disorders

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We describe a patient with focal epilepsy characterized by ictal asystole episodes and low-grade tumour over the left temporal neocortex. Non-invasive presurgical evaluation showed an epileptogenic zone extended beyond the lowgrade tumour. This extension was confirmed by intraoperative electrocorticography. One-stage surgery with anterior temporal lobe resection was performed. The patient was seizure-free after one year of follow-up. Detailed electroclinical and therapeutic reasoning with hypotheses defining epileptogenic and symptomatogenic networks are discussed.

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Section: Discussionmentioning

confidence: 99%

Low‐grade tumour over the left temporal neocortex and ictal asystole: network and surgical implications

Russo¹,

Francione²,

Martinoni³

et al. 2021

Epileptic Disorders

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“…Control of ictal arrhythmias is critical for safety in patients with epilepsy, as these arrhythmias may play a role in the pathophysiology of SUDEP. However, strong clinical evidence linking SUDEP and IB/IA is currently lacking [[41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52]]. Data from animal studies suggests that brief periods of IB/IA lasting a few seconds are likely benign.…”

Section: Discussionmentioning

confidence: 99%

Resolution of ictal bradycardia and asystole following temporal lobectomy: A case report, and review of available cases using pacemakers

Ballendine

Shahab

Perez-Careta

et al. 2019

Epilepsy & Behavior Reports

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Ictal bradycardia (IB) and ictal asystole (IA) are uncommonly recognized phenomena that increase morbidity in patients with epilepsy by causing syncope and seizure-related falls. These arrhythmias are also suspected to be involved in the pathophysiology of sudden unexpected death in epilepsy (SUDEP). We report a case of a 57-year-old male with left temporal lobe epilepsy who experienced both IB and IA. This patient was initially managed with pacemaker implantation, prior to undergoing left temporal lobectomy. Following surgery, the patient had no ongoing IB or IA on his pacemaker recordings, and his seizure control was greatly improved. His pacemaker was removed approximately one year post-operatively and he continued treatment with anti-seizure drugs (ASDs). A literature review of cases of IB and IA that were managed with pacemakers was performed. Pacemaker implantation appears to be quite effective for reducing seizure-related syncope and falls in the setting of IB/IA. Epilepsy surgery also seems to be an effective treatment option for IB/IA, as many patients are able to have their pacemakers removed post-operatively. Further investigations into the pathophysiology of IB and IA and long-term outcomes using different treatment modalities are clearly needed to help formulate treatment guidelines and, potentially, to reduce the occurrence of SUDEP in these patients.

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“…The epileptogenic properties of cocaine and most other amphetamines are well established (64,65). It could well be that asystole is a consequence of stimulant facilitated seizure activity spreading to the brainstem (60, 66,67). There is no compelling reason to think that common mechanisms could not be operating in both epileptics and stimulant abusers.…”

Section: Other Clinical Markersmentioning

confidence: 99%

Possible Strategies for the Diagnosis of Fatal Excited Delirium Syndrome

Karch

2012

Academic Forensic Pathology

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Excited Delirium Syndrome (ExDS) is a term traditionally used in forensic literature to describe the symptoms and signs seen in a subgroup of patients with delirium who die in an agitated state. Components of this syndrome are altered mental status, combativeness and/or aggressiveness, increased tolerance to significant pain, tachypnea, profuse sweating, severe agitation, elevated temperature, delirium, and noncompliance with law enforcement and medical personnel. The individual may display "superhuman" strength and wear clothing inappropriate for the environment. Patients with this presentation are almost guaranteed to cause difficulties for law enforcement officers and medical staff. This review is written in hopes of minimizing some of these difficulties by 1) increasing general awareness and specific knowledge about this condition, 2) explaining the neurochemical and neuroanatomical alterations that have been shown to cause those symptoms, and 3) by suggesting new lines of research that might identify easily measured biomarkers for the disease. If the disease mechanism can be deciphered, then it should be possible to devise effective strategies for treatment. It would also be of enormous value to the legal system. When defending a diagnosis before the court, physical evidence always trumps knowledge and experience. It would be far better to be able to present physical proof than to opine that the decedent's behavior was typical for the disease. In this aspect, ExDS is analogous to myocardial infarction: if a man dies suddenly, it is much easier to prove the cardiac origin of the event if an occlusive thrombus is found in a major coronary artery.

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Potentially Life-Threatening Ictal Bradycardia in Intractable Epilepsy

Cited by 10 publications

References 12 publications

Low‐grade tumour over the left temporal neocortex and ictal asystole: network and surgical implications

Low‐grade tumour over the left temporal neocortex and ictal asystole: network and surgical implications

Resolution of ictal bradycardia and asystole following temporal lobectomy: A case report, and review of available cases using pacemakers

Possible Strategies for the Diagnosis of Fatal Excited Delirium Syndrome

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