22. Seizure-induced ictal asystolia: A serious complication of seizures revealed by long-term video-EEG monitoring

Abstract

Sudden unexpected death in epilepsy (SUDEP) represents the main cause of death in patients with refractory epilepsy. A number of mechanisms have been proposed, including seizure-induced asystolia. We report two new patients with ictal asystolia revealed by long-term video-EEG monitoring. Case 1. A 76 year-old male with 1 year history of sudden falls to the ground associated with loss of consciousness, pallor and sweating, sometimes preceded by an olfactory hallucination. EEG: left temporal spikes. MRI: cerebral vascular changes. Case 2. A 55 year-old male with a 10 year history of focal seizures characterized by epigastric aura and loss of contact, more recently followed by sudden falls to the ground with pallor and stiffening. EEG: left temporal spikes. MRI: left temporal dysplasia. The video-EEG monitoring allowed to capture a number of seizures originating from the left temporal lobe and associated with ictal asystolia lasting for 10–20 s, with a corresponding syncope-like EEG picture. Focal seizures complicated by ictal asystolia may be suspected on clinical grounds by the appearance of syncope-like events preceded by typical epileptic auras. Long-term video-EEG recording is the gold standard to detect these events which may require pacemaker implantation.