Recurrent Syncope Triggered by Temporal Lobe Epilepsy: Ictal Bradycardia Syndrome

Kang, Do‐Yoon; Oh, Il-Young; Lee, So‐Ryoung; Choe, Wonyoung; Yoon, Junghan; Lee, Sang-Kun; Choi, Eue Keun; Oh, Seil

doi:10.4070/kcj.2012.42.5.349

Cited by 5 publications

(5 citation statements)

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“…Ictal motor behaviors suggestive of a seizure disorder (tonic and clonic contractions and automatisms) were described in four patients [31] , [34] , [35] , [36] . Finally, postictal confusion or focal neurological deficit was described in seven cases [4] , [25] , [29] , [30] , [36] , [40] , [43] . Overall, in the majority of cases, as in the described patient, seizure-related auras or ictal seizure-related semiology was lacking: blurred vision, dizziness, nausea, and light-headedness were the most commonly reported symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…There are relatively few reported cases of ictal asystole in the context of a new-onset/newly diagnosed epilepsy. Twenty-one articles in 31 patients (18 females) were fully analyzed [4] , [7] , [25] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] (see Table 1 ). The asystole was self-limiting in every case and lasted 20 s on average (ranging from 4 to 40 s).…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, subjective symptomatology suggestive of a focal seizure preceding loss of consciousness was reported in only seven out of 31 cases: visual illusion [27] , hallucinations [36] , jamais vu [43] , fear [37] , psychic aura [35] , and epigastric auras [28] , [42] . Ictal motor behaviors suggestive of a seizure disorder (tonic and clonic contractions and automatisms) were described in four patients [31] , [34] , [35] , [36] .…”

Section: Discussionmentioning

confidence: 99%

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Ictal asystole as the first presentation of epilepsy: A case report and systematic literature review

Giovannini

Meletti

2014

Epilepsy & Behavior Case Reports

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We report the case of a 69-year-old woman who presented with recurring episodes of mental confusion/dizziness followed by loss of consciousness, intense pallor, and sweating. Cardiologic investigations were unremarkable. The electroencephalogram recorded during one typical episode allowed the demonstration of a right frontotemporal seizure with progressive bradycardia leading to a 9-second asystole. Following levetiracetam treatment up to 2500 mg/day, seizures with ictal asystole (IA) recurred. An MRI compatible pacemaker was then implanted. At 26-month follow-up, the patient has not had further episodes of loss of consciousness. A systematic review (1950–Apr 2014) searching for cases in which IA was an early manifestation of epilepsy led to the observation of 31 cases. The time lag between the first seizures and the correct diagnosis of IA was long (average: 27 months; median: 12 months). Clinical history alone was not sufficient to prompt a correct diagnosis of IA, and only 11 out of 31 cases presented with symptoms suggestive of a seizure disorder. The majority of patients had a frontotemporal epilepsy with a slight prevalence of left-side involvement (19 out of 31).Ictal bradycardia–asystole is an important condition that should be recognized by epileptologists, neurologists, as well as emergency department physicians. It is important to underscore that IA not only can occur in patients with drug-resistant epilepsy but also may be the first manifestation of the patient's epilepsy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ictal asystole as the first presentation of epilepsy: A case report and systematic literature review

Giovannini

Meletti

2014

Epilepsy & Behavior Case Reports

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“…The presence of primary cardiac abnormalities is often considered sufficient cause, while they may in fact be a mere consequence of neurological pathology. Several previously published papers have shown cardiac rhythm changes in patients with epilepsy [1][2][3], brain lesions [4,5], or both [6]. In reported cases, brain tumor-associated syncope was also associated with other symptoms such as jamais vu, dizziness, and complex partial seizures with post-ictal confusion lasting for 30 minutes.…”

Section: Discussionmentioning

confidence: 84%

Bradycardia and syncope as sole manifestations of a cranial lesion: a case report

et al. 2020

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Background: Bradycardia and syncope are known sequelae of brain lesions. However, in the absence of neurological signs and symptoms, bradycardia and syncope are often investigated purely from the cardiovascular perspective and central nervous system-related causes may be easily overlooked during differential diagnosis. Case presentation: Here we report a case of a 69-year-old Caucasian man who presented to the emergency department after a fall. He had 1-year history of syncope and bradycardia with frequent ectopic beats shown on his electrocardiogram. He had no neurological symptoms. He was previously investigated as an outpatient and a diagnosis of idiopathic bradycardia with ventricular ectopic beats was made. On admission, cardiovascular investigations could not reveal the cause of his bradycardia. Computed tomography and magnetic resonance imaging scans of his head showed a localized mass in left basal ganglia consistent with infiltrating glioma. Conclusion: To the best of our knowledge this is the first case report demonstrating central nervous system-related bradycardia and syncope without other neurological symptoms. This case will serve as a useful reminder to general practitioners, accident and emergency doctors, and cardiologists.

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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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Recurrent Syncope Triggered by Temporal Lobe Epilepsy: Ictal Bradycardia Syndrome

Cited by 5 publications

References 10 publications

Ictal asystole as the first presentation of epilepsy: A case report and systematic literature review

Ictal asystole as the first presentation of epilepsy: A case report and systematic literature review

Bradycardia and syncope as sole manifestations of a cranial lesion: a case report

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

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