New onset left frontal lobe seizure presenting with ictal asystole

Enkiri, Sean A.; Ghavami, Forough; Anyanwu, Chinekwu; Eldadah, Zayd; Morrissey, Richard L.; Motamedi, Gholam K.

doi:10.1016/j.seizure.2011.07.012

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…There are relatively few reported cases of ictal asystole in the context of a new-onset/newly diagnosed epilepsy. Twenty-one articles in 31 patients (18 females) were fully analyzed [4] , [7] , [25] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] (see Table 1 ). The asystole was self-limiting in every case and lasted 20 s on average (ranging from 4 to 40 s).…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, subjective symptomatology suggestive of a focal seizure preceding loss of consciousness was reported in only seven out of 31 cases: visual illusion [27] , hallucinations [36] , jamais vu [43] , fear [37] , psychic aura [35] , and epigastric auras [28] , [42] . Ictal motor behaviors suggestive of a seizure disorder (tonic and clonic contractions and automatisms) were described in four patients [31] , [34] , [35] , [36] . Finally, postictal confusion or focal neurological deficit was described in seven cases [4] , [25] , [29] , [30] , [36] , [40] , [43] .…”

Section: Discussionmentioning

confidence: 99%

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Ictal asystole as the first presentation of epilepsy: A case report and systematic literature review

Giovannini

Meletti

2014

Epilepsy & Behavior Case Reports

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We report the case of a 69-year-old woman who presented with recurring episodes of mental confusion/dizziness followed by loss of consciousness, intense pallor, and sweating. Cardiologic investigations were unremarkable. The electroencephalogram recorded during one typical episode allowed the demonstration of a right frontotemporal seizure with progressive bradycardia leading to a 9-second asystole. Following levetiracetam treatment up to 2500 mg/day, seizures with ictal asystole (IA) recurred. An MRI compatible pacemaker was then implanted. At 26-month follow-up, the patient has not had further episodes of loss of consciousness. A systematic review (1950–Apr 2014) searching for cases in which IA was an early manifestation of epilepsy led to the observation of 31 cases. The time lag between the first seizures and the correct diagnosis of IA was long (average: 27 months; median: 12 months). Clinical history alone was not sufficient to prompt a correct diagnosis of IA, and only 11 out of 31 cases presented with symptoms suggestive of a seizure disorder. The majority of patients had a frontotemporal epilepsy with a slight prevalence of left-side involvement (19 out of 31).Ictal bradycardia–asystole is an important condition that should be recognized by epileptologists, neurologists, as well as emergency department physicians. It is important to underscore that IA not only can occur in patients with drug-resistant epilepsy but also may be the first manifestation of the patient's epilepsy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ictal asystole as the first presentation of epilepsy: A case report and systematic literature review

Giovannini

Meletti

2014

Epilepsy & Behavior Case Reports

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“…Ictal asystole (IA) is a severe complication of seizures. Since the first observation in 1906 (Russell, ), about 150 IA cases have been reported (Howell & Blumhardt, ; Reeves et al., ; Devinsky et al., ; Jallon, ; Kahane et al., ; Scott & Fish, ; Mondon et al., ; Rocamora et al., ; Rossetti et al., ; Britton et al., ; Carinci et al., ; Ghearing et al., ; Schuele et al., ; Zarraga & Ware, ; Novy et al., ; Bae et al., ; Beal et al., ; Enkiri et al., ; Lanz et al., ; Moseley et al., ; Serafini et al., ; Strzelczyk et al., ; Kukla et al., ; Marynissen et al., ; Sprimont et al., ; Stokes et al., ). IAs are probably underdetected, since a long‐term electrocardiogram (ECG) study has shown IA in 16% of patients with refractory epilepsy (Rugg‐Gunn et al., ).…”

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confidence: 99%

Characterization of seizure‐induced syncopes:EEG,ECG, and clinical features

et al. 2013

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SUMMARYObjective: Ictal bradycardia and ictal asystole (IA) are rare but severe complications of epileptic seizures. They are difficult to recognize within a seizure and their consequences remain unclear. Herein we aimed to extend the description of electrical and clinical features of seizures with IA and/or syncope. Methods: Among 828 patients with epilepsy who were admitted for presurgical videoelectroencephalogram (EEG) monitoring evaluation between 2003 and 2012, we selected those presenting IA and/or syncope. We studied the electroclinical sequence of these manifestations and their correlation with electrocardiogram (ECG), and we compared seizures with or without IA among the same patients. Results: Nine (1.08%) of 828 patients (four men, mean age 43 AE 6 years) showed IA. Six patients had temporal lobe epilepsy and the others had frontal, temporooccipital, or occipital epilepsy, demonstrated by intracranial EEG in two. In these patients, 59 of 103 recorded seizures induced a reduction of heart rate (HR), leading to IA in 26. IAs were mostly (80%) symptomatic, whereas ictal HR decreases alone were not. In seizures with IA, we identified usual ictal symptoms, and then symptoms related primarily to cerebral hypoperfusion (pallor, atonia, early myoclonic jerks, loss of consciousness, hypertonia, and fall) and secondarily to cerebral reperfusion (skin flushing, late myoclonic jerks). At 32 AE 18 s after the onset of the seizure, the HR decreased progressively during 11 AE 6 s, reaching a sinusal pause for 13 AE 7 s. The duration of the IA was strongly correlated with electroclinical consequences. IA was longer in patients with atonia (14.8 AE 7 vs. 5.7 AE 3 s), late myoclonic jerks (15.8 AE 7 vs. 8 AE 6 s), hypertonia (19 AE 4.5 vs. 8.3 AE 5 s), and EEG hypoperfusion changes (16 AE 5.6 vs. 6.9 AE 5.5 s). IA may induce a fall during atonia or hypertonia. Surface and intracerebral EEG recordings showed that ictal HR decrease and IA often occurred when seizure activity became bilateral. Finally, we identified one patient with ictal syncopes but without IA, presumably related to vasoplegia. Significance: We provide a more complete description of the electroclinical features of seizures with IA, of the mechanism of falls, and distinguish between hypoperfusion and reperfusion symptoms of syncope. Identification of the mechanisms of syncope may improve management of patients with epilepsy. A pacemaker can be proposed, when parasympathetic activation provokes a negative chronotropic effect that leads to asystole. It is less likely to be useful when vasoplegic effects predominate.

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“…Asystole duration and candidacy for epilepsy surgery have also been recommended as criteria to decide whether PM implantation is warranted [4]. This recommendation stems from the observation that asystole lasting longer than 4–6 s is associated with syncope and ictal falls [4,[30], [31], [32], [33], [34], [40]]. In our review, the average duration of IA was significantly higher than this range (15.6 ± 11.7 s), suggesting that many patients would benefit from pacing.…”

Section: Discussionmentioning

confidence: 99%

Resolution of ictal bradycardia and asystole following temporal lobectomy: A case report, and review of available cases using pacemakers

Ballendine

Shahab

Perez-Careta

et al. 2019

Epilepsy & Behavior Reports

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Ictal bradycardia (IB) and ictal asystole (IA) are uncommonly recognized phenomena that increase morbidity in patients with epilepsy by causing syncope and seizure-related falls. These arrhythmias are also suspected to be involved in the pathophysiology of sudden unexpected death in epilepsy (SUDEP). We report a case of a 57-year-old male with left temporal lobe epilepsy who experienced both IB and IA. This patient was initially managed with pacemaker implantation, prior to undergoing left temporal lobectomy. Following surgery, the patient had no ongoing IB or IA on his pacemaker recordings, and his seizure control was greatly improved. His pacemaker was removed approximately one year post-operatively and he continued treatment with anti-seizure drugs (ASDs). A literature review of cases of IB and IA that were managed with pacemakers was performed. Pacemaker implantation appears to be quite effective for reducing seizure-related syncope and falls in the setting of IB/IA. Epilepsy surgery also seems to be an effective treatment option for IB/IA, as many patients are able to have their pacemakers removed post-operatively. Further investigations into the pathophysiology of IB and IA and long-term outcomes using different treatment modalities are clearly needed to help formulate treatment guidelines and, potentially, to reduce the occurrence of SUDEP in these patients.

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New onset left frontal lobe seizure presenting with ictal asystole

Cited by 7 publications

References 9 publications

Ictal asystole as the first presentation of epilepsy: A case report and systematic literature review

Ictal asystole as the first presentation of epilepsy: A case report and systematic literature review

Characterization of seizure‐induced syncopes:EEG,ECG, and clinical features

Resolution of ictal bradycardia and asystole following temporal lobectomy: A case report, and review of available cases using pacemakers

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