Syncope, Epilepsy and Ictal Asystole: A Case Series and Narrative Review

Sowden, N.; Booth, Cameron; Kaye, G.

doi:10.1016/j.hlc.2021.07.003

Cited by 8 publications

(7 citation statements)

References 43 publications

(68 reference statements)

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“…They are invasive and costly but have shown effective in diagnosing syncope in some one-eighth of patients previously diagnosed with epilepsy [ 15 ]. ILRs have also been shown to confirm epilepsy diagnosis in a small case series [ 15 , 16 ]. ILRs have also been shown to be useful for patients with infrequent seizures [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Wearable external loop recorders (ELRs) such as “HeartBug” are also useful in investigating episodes of unexplained syncope. They continuously monitor cardiac rhythm and save events triggered by the patient or in response to auto triggers such as brady or tachyarrhythmias [ 16 ]. If AEEG tests are unavailable in medical institutions, ILR and ELR are alternatives for detecting cardiac arrhythmia episodes.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment is not recommended for symptomatic ictal bradyarrhythmia. A recent algorithm developed by Sowden et al may assist in diagnosing and managing patients suspected of IA [ 16 ]. While antiseizure medications and surgical interventions have been shown to reduce ictal arrhythmias effectively, the use of cardiac pacemakers is still debated.…”

Section: Discussionmentioning

confidence: 99%

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Syncope vs. Seizure: Ictal Bradycardia and Ictal Asystole

Ouchida,

Parratt,

Nikpour

et al. 2024

Case Reports in Neurological Medicine

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Background. Ictal arrhythmia is a rare condition that causes arrhythmic manifestations induced by epileptic seizures, including asystole or bradycardia. Ictal asystole (IA) is a very rare condition found in patients undergoing video-encephalography (EEG) monitoring. It is often related to temporal lobe epilepsy and can cause syncope, which can lead to injury or even death. Case Presentation. Two patients with epilepsy showed symptoms of syncope. Both patients underwent 4-day ambulatory EEG tests and were diagnosed with IA. Following the tests, the patients were implanted with a permanent pacemaker, and one of them underwent a temporal lobectomy. As a result of these procedures, the patients experienced a reduction in episodes of symptomatic syncope. Conclusion. Patients with ictal asystole and symptomatic ictal bradycardia are at increased risk of falls due to seizures. Although there are no specific guidelines for managing this condition, antiseizure medications, epilepsy surgery, and cardiac pacemaker implantation have been effective treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Syncope vs. Seizure: Ictal Bradycardia and Ictal Asystole

Ouchida,

Parratt,

Nikpour

et al. 2024

Case Reports in Neurological Medicine

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“…Seizure-induced ictal asystole and syncopes. Over the years, a conspicuous number of IA cases have been reported whose electro-clinical symptoms have been fully described [ 12 , 13 , 14 ]. In detail, in 2017, Tenyi et al [ 14 ] reviewed the available literature and quoted 157 cases of IA.…”

Section: Clinical Cardiovascular Events Connected To Seizuresmentioning

confidence: 99%

The Heart and Seizures: Friends or Enemies?

Pasini,

Michelucci

2023

JCM

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The heart and seizures are closely linked by an indissoluble relationship that finds its basis in the cerebral limbic circuit whose mechanisms remain largely obscure. The differential diagnosis between seizures and syncopes has always been a cornerstone of the collaboration between cardiologists and neurologists and is renewed as a field of great interest for multidisciplinary collaboration in the era of the diffusion of prolonged telemonitoring units. The occurrence of ictal or post-ictal arrhythmias is currently a cause of great scientific debate with respect to the role and risks that these complications can generate (including sudden unexpected death in epilepsy). Furthermore, the study of epileptic seizures and the arrhythmological complications they cause (during and after seizures) also allows us to unravel the mechanisms that link them. Finally, intercritical arrhythmias may represent great potential in terms of the prevention of cardiological risk in epileptic patients as well as in the possible prediction of the seizures themselves. In this paper, we review the pertaining literature on this subject and propose a scheme of classification of the cases of arrhythmia temporally connected to seizures.

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“…Although epilepsy is not considered syncope, as it is not associated with transient loss of consciousness, there are reported cases of epilepsy patients responding to antibradycardia pacing [47] while it is well known that some epilepsy patients die suddenly implicating arrhythmia mechanism of central origin [48]. It is uncommon to encounter syncopal patients exhibiting several syncope mechanisms, either benign or potentially malignant during a thorough diagnostic approach [41].…”

Section: Diagnostic Approachmentioning

confidence: 99%

Unexplained Syncope: The Importance of the Electrophysiology Study

Doundoulakis

Σουλαϊδόπουλος

Αρσένος

et al. 2021

Hearts

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Syncope of cardiac origin may be associated with an increased risk of sudden cardiac death if not treated in a timely and appropriate manner. The diagnostic approach of syncope imposes a significant economic burden on society. The investigation and elucidation of the pathogenetic mechanism of syncope are of great clinical importance, as both prognosis and appropriate therapeutic approaches depend on these factors. The responsible mechanism of presyncope or syncope can only be revealed through the patient history, baseline clinical examination and electrocardiogram. The percentage of patients who are diagnosed with these tests alone exceeds 50%. In patients with a history of organic or acquired heart disease or/and the presence of abnormal findings on the electrocardiogram, a further diagnostic electrophysiology inclusive approach should be followed to exclude life threatening arrhythmiological mechanism. However, if the patient does not suffer from underlying heart disease and does not show abnormal electrocardiographic findings in the electrocardiogram, then the probability in the electrophysiology study to find a responsible cause is small but not absent. The role of a two-step electrophysiology study inclusive risk stratification approach for the effective management of the former is thoroughly discussed in this review.

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Syncope, Epilepsy and Ictal Asystole: A Case Series and Narrative Review

Cited by 8 publications

References 43 publications

Syncope vs. Seizure: Ictal Bradycardia and Ictal Asystole

Syncope vs. Seizure: Ictal Bradycardia and Ictal Asystole

The Heart and Seizures: Friends or Enemies?

Unexplained Syncope: The Importance of the Electrophysiology Study

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