Video-electrographic and clinical features in patients with ictal asystole

Schuele, Stephan; Bermeo, Adriana C.; Alexopoulos, Andreas V.; Locatelli, Eduardo; Burgess, Richard C.; Dinner, Dudley S.; Foldvary‐Schaefer, Nancy

doi:10.1212/01.wnl.0000266595.77885.7f

Cited by 229 publications

(233 citation statements)

References 44 publications

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“…Alternatively, propagation to both orbitofrontal, temporal or insular cortices may be responsible for asystole. The disappearance of severe atonic seizures in individual 2 after the installation of PM suggests that ictal atonia may be explained in some seizures by asystole rather than by the epileptic activity itself, as reported by others 12 .…”

Section: Discussionsupporting

confidence: 61%

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: Discussionsupporting

confidence: 61%

Potentially Life-Threatening Ictal Bradycardia in Intractable Epilepsy

Odier

Nguyen²,

Bouthillier³

et al. 2009

Can. j. neurol. sci.

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“…Only one case series was reported on epilepsy types: almost twice as many people with temporal lobe epilepsy were monitored with vEEG compared to those with extra temporal lobe or generalised epilepsy. 6 This may have resulted in an overestimation of the association of temporal lobe epilepsy in those with ictal and postictal asystole. Diagnostic validity is another potential limitation as we included cases of AF (n=11) and VF (n=1) without vEEG.…”

Section: Limitationsmentioning

confidence: 99%

Cardiac arrhythmias during or after epileptic seizures

Lende

Surges

Sander

et al. 2015

Autonomic Neuroscience

120

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“…Cardiorespiratory abnormalities are more often reported in patients with temporal lobe epilepsy, where there is evidence of ictal and interictal autonomic dysregulation, predominantly with sympathetic overactivity 26 . Alterations in heart rate variability have been reported not only in adults but also in children with epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization

Almeida

Nunes

Palmini

et al. 2010

Arq. Neuro-Psiquiatr.

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Objective: The aim of this study was to verify incidence and characteristics of sudden unexpected death in patients (SUDEP) with refractory epilepsy and its relation to previous surgery and lesion localization. Method: A cross sectional study was carried out in a cohort of 550 patients with refractory epilepsy followed up by the Epilepsy Surgery Program of the University Hospital of PUCRS, Porto Alegre, Brazil, between January, 1992 and July, 2002. Patients were allocated in two groups (operated and non operated). Seizure type, distribution of interictal spikes and MRI findings were correlated with the SUDEP outcome. Results: The estimated incidence of probable SUDEP amounted to 29:1000 individuals. Probable SUDEP occurred in 1.2% of the 166 patients of the non operated group and in 3.7% of the 384 patients who were operated (OR=3.02, 95% CI 0.69-13.16) (p=0.11). Comparing patients who died to patients alive in the operated group a significant difference was observed concerning the following variables: SUDEP patients had a predominance of generalized seizures (p=0.002), extratemporal lesion on MRI (p<0.001) and epileptiform activity over extratemporal regions (p=0.001). Conclusion: In surgically treated patients with refractory epilepsy, an extratemporal location of the lesion and of the epileptiform discharges significantly correlated to SUDEP. Thus it is possible that in those patients; the underlying disease may play a role in the pathogenesis of SUDEP. Key words: SUDEP, refractory epilepsy, epilepsy surgery, extratemporal epilepsy.Incidência de SUDEP numa coorte de pacientes com epilepsia refratária: papel da cirurgia e da localização da lesão RESUMO Objetivo: O objetivo deste estudo é avaliar a incidência e características de morte súbita em pacientes com epilepsia refratária (SUDEP) e sua relação com cirurgia prévia e localização da lesão. Método: Estudo de Coorte realizado com 550 pacientes com epilepsia refratária seguidos no Programa de Epilepsia do Hospital Universitário da PUCRS, Porto Alegre, Brasil, entre Janeiro, 1992 e Julho, 2002. Os pacientes foram distribuídos em dois grupos (operados e não operados). Tipo de epilepsia, distribuição das descargas interictais e achados em RNM foram correlacionados com SUDEP. Resultados: A incidência estimada de SUDEP foi 29:1000 indivíduos. A incidência de provável SUDEP nos 166 pacientes do grupo de não operados foi 1,2% e nos 384 pacientes no grupo operado 3,7% (OR=3,02, 95% IC 0,69-13,16) (p=0,11). Comparando os pacientes que morreram com os sobreviventes do grupo operado houve diferença significativa nas seguintes variáveis: pacientes com SUDEP apresentam uma predominância de crises epilépticas generalizadas (p=0,002), lesões extratemporais na RNM (p<0,001) e atividade epileptiforme na região extratemporal (p=0,001). Conclusão: A localização da lesão e as descargas extratemporais em pacientes tratados cirurgicamente com epilepsia refratária correlacionaram-se significativamente com SUDEP. Então, é possível que nestes pacientes uma doença sobrejacent...

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Video-electrographic and clinical features in patients with ictal asystole

Cited by 229 publications

References 44 publications

Potentially Life-Threatening Ictal Bradycardia in Intractable Epilepsy

Potentially Life-Threatening Ictal Bradycardia in Intractable Epilepsy

Cardiac arrhythmias during or after epileptic seizures

Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization

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