Abstract
BackgroundIctal asystole is a rare phenomenon. Most reported cases are in persons with long-standing focal epilepsy originating from the temporal lobe. Its occurrence may complicate the clinical presentation or delay diagnosis, and it is thought to be associated with increased risk of sudden unexpected death in epilepsy.Case presentationWe report the case of a 55-year-old female person with epilepsy who suffered ictal asystole for 10 s while under monitoring at the Epilepsy Monitoring Unit. We then review briefly the pathophysiology and current management modalities for this phenomenon.DiscussionThe first step in management of this condition is usually the optimization of anti-seizure drugs. In our case, a 2-year fall-free period was achieved with optimization of medical treatment. Pacemaker implantation can also be attempted to prevent ictal asystole-related falls and injury, while refractory cases may benefit from epilepsy surgery in terms of both seizure control and prevention of ictal asystole.
Highlights
Pacemaker implantation can be attempted to prevent ictal asystole-related falls and injury, while refractory cases may benefit from epilepsy surgery in terms of both seizure control and prevention of ictal asystole
There are reports that link the occurrence of ictal bradyarrhythmia (IB) and ictal asystole (IA) with an increased risk of sudden unexpected death in epilepsy (SUDEP) [7, 8]
In agreement with other previous studies [11, 12], a recent systematic review in 2017 [13] which examined 157 case reports of patients with IA identified the left hemisphere (62% of cases included in the systematic review) and the temporal lobes (80–82%) as the most frequent seizure onset zone with associated IA
Summary
In agreement with other previous studies [11, 12], a recent systematic review in 2017 [13] which examined 157 case reports of patients with IA (between 1983 and 2016) identified the left hemisphere (62% of cases included in the systematic review) and the temporal lobes (80–82%) as the most frequent seizure onset zone with associated IA It confirmed previous data [3, 12] that linked IA to focal-onset (100% of cases included in the systematic review), long-standing, and drug-resistant epilepsy (72%). Ictal arrhythmias are thought to result from an imbalance between sympathetic and parasympathetic autonomic cardiovascular discharges [2], with higher parasympathetic outflow leading to IB and IA This imbalance is hypothesized to be the result of seizureinduced hyperexcitation coupled with chronic changes in neuronal networks secondary to drug-resistant epilepsy [13, 14].
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