Focal cortical dysplasia with prolonged ictal asystole, a case report

wali, Ahmad; Siddiqui, Fowzia

doi:10.1016/j.cnp.2020.10.002

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…The presence of FCD was higher in patients with IB/IA compared to those without (75% vs. 9%), and this association remained significant after correction for multiple comparisons. As previously reported, when FCDs are located in the temporal and insular cortices, they might manifest with IA/IB [29,30]. However, although several structural alterations (hippocampal sclerosis/atrophy, neoplasms, developmental abnormality, post-traumatic lesions, cavernomas, and infectious encephalitis) have been reported in epilepsy patients with IA/IB [13,31], large population studies have not identified a clear correlation between neuroimaging findings and IA/IB [13].…”

Section: The Role Of Structural and Genetic Factorsmentioning

confidence: 83%

Ictal Bradycardia and Asystole in Sleep-Related Hypermotor Epilepsy: A Study of 200 Patients

Muccioli,

Bruschi,

Ferri

et al. 2024

JCM

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Background: Ictal bradycardia (IB) and asystole (IA) represent a rare but potentially harmful feature of epileptic seizures. The aim of this study was to study IB/IA in patients with sleep-related hypermotor epilepsy (SHE). Methods: We retrospectively included cases with video-EEG-confirmed SHE who attended our Institute up to January 2021. We reviewed the ictal polysomnography recordings focusing on ECG and identified cases with IB (R-R interval ≥ 2 s or a ≥10% decrease of baseline heart rate) and IA (R-R interval ≥ 4 s). Results: We included 200 patients (123 males, 61.5%), with a mean age of 42 ± 16 years. Twenty patients (20%) had focal cortical dysplasia (FCD) on brain MRI. Eighteen (out of 104 tested, 17.3%) carried pathogenic variants (mTOR pathway, n = 10, nAchR subunits, n = 4, KCNT1, n = 4). We identified IB/IA in four cases (2%): three had IA (mean 10 s) and one had IB. Three patients had FCD (left fronto-insular region, left amygdala, right mid-temporal gyrus) and two had pathogenic variants in DEPDC5; both features were more prevalent in patients with IB/IA than those without (p = 0.003 and p = 0.037, respectively). Conclusions: We identified IB/IA in 2% of patients with SHE and showed that this subgroup more frequently had FCD on brain MRI and pathogenic variants in genes related to the mTOR pathway.

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Section: The Role Of Structural and Genetic Factorsmentioning

confidence: 83%

Ictal Bradycardia and Asystole in Sleep-Related Hypermotor Epilepsy: A Study of 200 Patients

Muccioli,

Bruschi,

Ferri

et al. 2024

JCM

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“…Focal cortical dysplasia in the temporal region including the Ic is suggested to cause ictal bradycardia and ictal asystole. A 15-year-old epileptic patient with focal dysplasia of the cerebral cortex that included both the right and left Ic showed prolonged asystole in relation to seizures and syncope [ 29 ]. In addition, a 25-year-old patient revealed asystole induced by Ic seizures, which was confirmed based on intracerebral electroencephalography.…”

Section: The Brain–heart Connectionmentioning

confidence: 99%

Sex Hormone-Specific Neuroanatomy of Takotsubo Syndrome: Is the Insular Cortex a Moderator?

2022

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Takotsubo syndrome (TTS), a transient form of dysfunction in the heart’s left ventricle, occurs predominantly in postmenopausal women who have emotional stress. Earlier studies support the concept that the human circulatory system is modulated by a cortical network (consisting of the anterior cingulate gyrus, amygdala, and insular cortex (Ic)) that plays a pivotal role in the central autonomic nervous system in relation to emotional stressors. The Ic plays a crucial role in the sympathovagal balance, and decreased levels of female sex hormones have been speculated to change functional cerebral asymmetry, with a possible link to autonomic instability. In this review, we focus on the Ic as an important moderator of the human brain–heart axis in association with sex hormones. We also summarize the current knowledge regarding the sex-specific neuroanatomy in TTS.

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“…We have read the case report by Wali and Siddiqui (2021) about a patient with epilepsy and focal cortical dysplasia including the insular cortex (Ic) in relation to prolonged ictal asystole. They suggested that the abnormal Ic activity was associated with autonomic instability underlying the pathophysiology of adverse effects on the patient's cardiovascular system.…”

mentioning

confidence: 99%

“…They suggested that the abnormal Ic activity was associated with autonomic instability underlying the pathophysiology of adverse effects on the patient's cardiovascular system. We note that several points should be taken into consideration to understand the etiology of the patient described by Wali and Siddiqui (2021) .…”

mentioning

confidence: 99%

Is the left insular cortex associated with the exaggerated activity in the parasympathetic nervous system?

Nagai

Kato

Dote

2021

Clinical Neurophysiology Practice

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Focal cortical dysplasia with prolonged ictal asystole, a case report

Cited by 3 publications

References 20 publications

Ictal Bradycardia and Asystole in Sleep-Related Hypermotor Epilepsy: A Study of 200 Patients

Ictal Bradycardia and Asystole in Sleep-Related Hypermotor Epilepsy: A Study of 200 Patients

Sex Hormone-Specific Neuroanatomy of Takotsubo Syndrome: Is the Insular Cortex a Moderator?

Is the left insular cortex associated with the exaggerated activity in the parasympathetic nervous system?

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