Ictal Asystole in Drug-Resistant Focal Epilepsy: Two Decades of Experience from an Epilepsy Monitoring Unit.

Sara Casciato,Pier Paolo Quarato,Alfredo D’Aniello,Giovanni Assenza,Roberta Morace,Carlo Di Bonaventura,Addolorata Mascia,Vincenzo Esposito,Giancarlo Di Gennaro,Luigi Pavone,Mario Tombini

doi:10.3390/brainsci10070443

Abstract

Background: Ictal asystole (IA) is a rare event observed in people with epilepsy (PwE). Clinical and IA video-electroencephalographic findings may be helpful in screening for high-risk subjects. Methods: From all PwE undergoing video-EEG for presurgical evaluation between 2000 and 2019, we retrospectively selected those with at least one IA (R–R interval of ≥3 s during a seizure). Results: IA was detected in eight out of 1088 (0.73%) subjects (mean age: 30 years; mean epilepsy duration: 9.6 years). Four out of them had a history of atonic falls. No patients had cardiac risk factors or cardiovascular diseases. Seizure onset was temporal (n = 5), temporo-parietal (n = 1) or frontal (n = 2), left-sided and right-sided in five and two patients, respectively. In one case a bilateral temporal independent seizure onset was recorded. IA was recorded in 11 out of 18 seizures. Mean IA duration was 13 s while mean IA latency from seizure onset was 26.7 s. Symptoms related to IA were observed in all seizures. Conclusion: IA is a rare and self-limiting event often observed during video-EG in patients with a history of atonic loss of consciousness and/or tardive falls in the course of a typical seizure.

Highlights

Ictal asystole (IA), defined as an R-R interval longer than 3 s [1,2,3], is a rare complication occurring during a seizure, affecting about 0.3% of people with drug-resistant epilepsy who underwent video-EEG monitoring [1]
Published case series and reviews of the literature suggest that people with temporal lobe epilepsy (TLE) may be at increased risk for ictal bradycardia and IA and, a left-sided epileptogenesis has been suggested, larger series did not confirm a consistent lateralization [1,6]
With the aim to examine the prevalence of IA and its electro-clinical characteristics, we retrospectively reviewed a large sample of pre-surgical video-EEG long-term monitoring (LTM)

Summary

Introduction

Ictal asystole (IA), defined as an R-R interval longer than 3 s [1,2,3], is a rare complication occurring during a seizure, affecting about 0.3% of people with drug-resistant epilepsy who underwent video-EEG monitoring [1]. Ictal asystole is a potentially serious event, because it may cause syncope-related falls and injuries [2,3,4] that can be prevented by implanting a cardiac pacemaker [3,4,5]. IA may be clinically suspected when patients report a sudden loss of consciousness with falls, an established diagnosis requires simultaneous video-EEG and ECG monitoring. Ictal asystole (IA) is a rare event observed in people with epilepsy (PwE). 2019, we retrospectively selected those with at least one IA (R–R interval of ≥3 s during a seizure)

Methods

Results

Discussion

Conclusion