Ictal asystole as a manifestation of pure insular epilepsy

Hagiwara, Koichi; Okadome, Toshiki; Mukaino, Takahiko; Uehara, Taira; Tanaka, Hideaki; Kamada, Takashi; Miyoshi, Ayako; Akamatsu, Naoki; Ohara, Shuichi; Sekiya, Hiroshi

doi:10.1016/j.seizure.2021.06.026

Cited by 7 publications

(4 citation statements)

References 4 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: 84%

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: 84%

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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“…In most reported cases, ictal bradycardia and asystole (IA) were associated with focal seizures originating from the temporal lobe with only a slight left predominance [2][3][4][5][6][7]9]. Interestingly, a few cases of IA recorded during an SEEG recording showed an insular origin of the responsible seizures, confirming the involvement of the limbic system [10,11].…”

Section: Ictal Arrhythmiasmentioning

confidence: 96%

The Heart and Seizures: Friends or Enemies?

Pasini,

Michelucci

2023

JCM

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The heart and seizures are closely linked by an indissoluble relationship that finds its basis in the cerebral limbic circuit whose mechanisms remain largely obscure. The differential diagnosis between seizures and syncopes has always been a cornerstone of the collaboration between cardiologists and neurologists and is renewed as a field of great interest for multidisciplinary collaboration in the era of the diffusion of prolonged telemonitoring units. The occurrence of ictal or post-ictal arrhythmias is currently a cause of great scientific debate with respect to the role and risks that these complications can generate (including sudden unexpected death in epilepsy). Furthermore, the study of epileptic seizures and the arrhythmological complications they cause (during and after seizures) also allows us to unravel the mechanisms that link them. Finally, intercritical arrhythmias may represent great potential in terms of the prevention of cardiological risk in epileptic patients as well as in the possible prediction of the seizures themselves. In this paper, we review the pertaining literature on this subject and propose a scheme of classification of the cases of arrhythmia temporally connected to seizures.

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“…In addition, a 25-year-old patient revealed asystole induced by Ic seizures, which was confirmed based on intracerebral electroencephalography. A recent investigation using hybrid PET-magnetic resonance imaging (MRI) revealed hypometabolism in the posterior Ic in the right hemisphere and a fluid-attenuated inversion recovery hyperintensity in the same Ic region [ 30 ]. In a whole-brain statistical analysis of PET images, hypometabolism in the right posterior Ic was shown in epileptic patients with ictal asystole compared to healthy subjects and epileptic patients without ictal asystole [ 31 ].…”

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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Ictal asystole as a manifestation of pure insular epilepsy

Cited by 7 publications

References 4 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

The Heart and Seizures: Friends or Enemies?

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

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