The ictal bradycardia syndrome should be considered in patients with unusual or refractory episodes of syncope, or in patients with a history suggestive of both epilepsy and syncope. It suggests seizure onset in temporal lobe, and is more commonly diagnosed in males. Diagnosis may be aided by ambulatory EEG/ECG monitoring. Cardiac pacemaker implantation along with antiepileptic drug therapy may be necessary to minimize the possibility of death.

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Clinical characteristics of 12 patients with carotid occlusive disease who experienced episodes of repetitive involuntary movement were analyzed and correlated with laboratory findings. The majority of patients had rhythmic involuntary movements of one or both extremities on one side, which were characteristically precipitated by standing, walking, or hyperextension of the neck and were promptly alleviated by assuming a sitting or supine position. Six patients had a history of a prior transient ischemic attack or stroke. Electroencephalograms contained no epileptiform activity at rest or during sleep in any patient or during the involuntary movements in 2 patients. Cerebral angiography revealed either occlusion or high-grade stenosis of the internal or common carotid artery on the side opposite the involuntary movement in all patients. We conclude that the repetitive involuntary movements result from transient hemodynamic ischemic episodes rather than partial (focal) epilepsy.

Accumulated experience has delineated numerous distinctive electroencephalographic (EEG) patterns that are morphologically epileptiform but have no relationship to the process responsible for generating epileptic seizures and have little or no practical value for diagnosis. These anomalous patterns need to be distinguished carefully from the highly abnormal types of EEG activity that continue to have important diagnostic value.

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