Ictal asystole—Late manifestation of partial epilepsy and importance of cardiac pacemaker
نویسندگان
چکیده
Ictal asystole (IA) is a life-threatening complication of epilepsy and is a potential mechanism of sudden unexplained death in epilepsy (SUDEP). This entity has been proven by multiple case reports and small case series. The management of the patients with IA is still in early phase of discussion. We report a patient with medically intractable cryptogenic partial epilepsy for 27 years who presented with new onset drop attacks. During the epilepsy monitoring unit stay he was found to have a left fronto-temporal partial onset seizures which triggered brady-arrhythmia followed by asystole for 20s. A cardiac pacemaker was implanted and the patient was followed for 2 years. He continued to have simple and complex partial seizures but did not have drop attacks anymore. He still occasionally feels the activation of his pacemaker during simple partial phase of his seizures but the characteristic loss of muscle tone never happened again which made him highly satisfied. Our case demonstrates that IA can even happen decades after the onset of epilepsy. Cardiac pacemaker should be considered in all patients with IA as it prevents ictal falls and possibly SUDEP.
منابع مشابه
Clinical commentary with video sequences Ictal asystole in temporal lobe epilepsy before and after pacemaker implantation
Events of ictal bradycardia or asystole may be of relevance in epilepsy patients presenting with ictal falls, and are a potential contributor to SUDEP. The literature on ictal bradycardia or asystole is anecdotal and consists of case reports and small case series. There are no guidelines for the care of patients with ictal arrythmias. Insertion of cardiac pacemakers may prevent life-threatening...
متن کاملIctal asystole in temporal lobe epilepsy before and after pacemaker implantation.
Events of ictal bradycardia or asystole may be of relevance in epilepsy patients presenting with ictal falls, and are a potential contributor to SUDEP. The literature on ictal bradycardia or asystole is anecdotal and consists of case reports and small case series. There are no guidelines for the care of patients with ictal arrhythmias. Insertion of cardiac pacemakers may prevent life-threatenin...
متن کاملCardiac asystole during a temporal lobe seizure
The association between temporal lobe seizures and cardiac arrhythmias has been anecdotally reported in the literature. Ictal bradycardia and cardiac asystole are rare, and maybe underestimated. The physiological mechanism is poorly understood. We report a patient with left temporal lobe seizures who developed ictal bradycardia and cardiac asystole during a complex partial seizure and required ...
متن کاملIctal bradyarrhythmias and asystole requiring pacemaker implantation: Combined EEG–ECG analysis of 5 cases
BACKGROUND Seizures can lead to cardiac arrhythmias by a number of mechanisms including activation/inhibition of cortical autonomic centers, increase in vagal tone through activation of brainstem reflex centers, and respiratory failure. Ictal asystole (IA) is a potential mechanism underlying sudden unexpected death in epilepsy (SUDEP). We analyzed the clinical features of 5 patients who develop...
متن کاملNew onset left frontal lobe seizure presenting with ictal asystole
Ictal asystole is a presumably rare but potentially fatal complication of seizures, most often of temporal lobe origin. It is believed that at least some cases of sudden unexplained death in epilepsy (SUDEP) might be triggered by ictal bradycardia or asystole. Current standard practice is to implant a permanent pacemaker in these patients to prevent syncope and/or death. However, emerging data ...
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ورودعنوان ژورنال:
- Seizure
دوره 18 شماره
صفحات -
تاریخ انتشار 2009