Syncope and Ictal Asystole Caused by Temporal Lobe Epilepsy

Kohno, Ritsuko; Abe, Haruhiko; Akamatsu, Naoki; Oginosawa, Yasushi; Tamura, Masahito; Takeuchi, Masaaki

doi:10.1253/circj.cj-11-0261

Cited by 11 publications

(10 citation statements)

References 16 publications

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“…1 It has been reported that AeD therapies are generally highly effective to TLE in adult patients, 13,14 while the effectiveness of permanent pacemaker therapy for IA/bradycardia has been still controversial in epilepsy patients. 2,3,8,9 In the present study, 4 patients (cases 1-4) received both pacemaker implantation and therapeutic doses of AeDs. These patients did not experience T-LOC recurrence or epileptic seizures after optimizing AeD therapies.…”

Section: Discussionmentioning

confidence: 97%

“…In this regard, in a previous case report we showed T-LOC with prolonged asystole of 18 seconds caused by right lateral TLE. 9 In general, ictal sinus tachycardia is the most common finding during an episode of epileptic seizure. However, as observed in several of our patients, tachycardia may subsequently lead to severe bradyarrhythmia associated with T-LOC.…”

Section: Discussionmentioning

confidence: 99%

“…Others have observed this sequence of events as well. [9][10][11] For example, Schuele et al 4 reported a transient increase in sinus rate (due to increase of sympathetic activities) and subsequent gradual decrease, resulting in marked sinus bradycardia and asystole (due to increase of parasympathetic activity). This pattern was virtually the same as that in patients with vasovagal asystole.…”

Section: Discussionmentioning

confidence: 99%

“…The patient then underwent a 16-channel EEG using a 10-20 system, which revealed the presence of inter-ictal epileptiform discharges over both anterior temporal regions. 9 He was diagnosed as having TLE associated with ictal bradycardia and asystole. His symptoms disappeared after initiation of therapy with oral carbamazepine at 100 mg daily, though the ILR continued to record asymptomatic nocturnal bradycardia and asystole.…”

Section: Casementioning

confidence: 99%

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Long‐Term Follow‐Up of Ictal Asystole in Temporal Lobe Epilepsy: Is Permanent Pacemaker Therapy Needed?

Kohno

Abe

Akamatsu

et al. 2016

Cardiovasc electrophysiol

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Casementioning

confidence: 99%

See 2 more Smart Citations

Long‐Term Follow‐Up of Ictal Asystole in Temporal Lobe Epilepsy: Is Permanent Pacemaker Therapy Needed?

Kohno

Abe

Akamatsu

et al. 2016

Cardiovasc electrophysiol

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“…The differential diagnosis in elderly individuals presenting with TLOC is particularly challenging, as it often occurs in the context of underlying cardiovascular and potentially neurological structural disease and in many cases may present with symptoms that are atypical for either syncope or seizures. 10,11) The previously reported incidence of epileptic seizures is as high as 10.9% after subarachnoid hemorrhages 12) and 7.7% after hemorrhagic cerebral infarctions. 13) In most clinical settings, the presence or absence of convulsions or abnormal movement is judged by the information from the patient's clinical manifestations by the witness.…”

Section: Discussionmentioning

confidence: 99%

Subclinical Tonic-Clonic Epileptic Seizure Detected by an Implantable Loop Recorder

et al. 2013

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SummaryA 73-year old man received an implantable loop recorder (ILR) for the evaluation of transient loss of consciousness (TLOC) spells. His medical history was without any epileptic convulsions or automatism. ILR recording during a spontaneous episode revealed the presence of a regular, narrow QRS complex tachycardia associated with low-amplitude, high-frequency, continuous or discontinuous artifacts, consistent with myopotentials. During the event, the regular, lowamplitude continuous signals gradually became discontinuous, with a prolongation of the inter-signal cycle length, until their disappearance after manual activation of the ILR. The patient was diagnosed as experiencing subclinical tonic-clonic epileptic seizures. Antiepileptic drug treatment was initiated, and the patient has remained free of TLOC symptoms during 13 months follow-up. (Int Heart J 2013; 54: 289-291) Key words: Epilepsy, Syncope, Loss of consciousness T he implantable loop recorder (ILR) is a useful instrument for detection of heart rhythm disturbances in patients with transient loss of consciousness (TLOC) spells of unknown origin. For the most part ILRs have proven to be of greatest value in determining an arrhythmic basis for syncope, 1,2) and on occasion have been helpful in demonstrating that certain patients believed to be suffering from epilepsy, but whose symptoms are 'drug-refractory', may in fact be suffering from syncope.3) However, the ability of an ILR to unmask a seizure disorder in patients in whom the cause of TLOC is undetermined despite the usual investigations has been largely overlooked.Previous reports of ILR use in recurrent transient loss of consciousness (TLOC) in drug refractory epileptic patients have been published, and an association between ILR recorded myopotentials and clinically documented convulsive symptoms have been observed. 4,5) The present case describes a patient presenting with TLOC in the absence of apparent convulsions, in whom ILR monitoring detected myopotentials consistent with a subclinical epileptic seizure. Case ReportA 73-year-old man with a history of prior remote myocardial infarction and a 4-month-old hemorrhagic cerebral infarction was referred for evaluation of TLOC. The episode was characterized by sudden skin pallor followed by an abrupt fall onto the floor from a seating position in absence of convulsion. The episode lasted approximately 30 to 60 sec, and the patient regained consciousness immediately but sustained facial injuries from the fall. He denied having experienced palpitations or chest pain before or after the spell. His wife, who witnessed the episode, reported that the patient suddenly became pale and unresponsive to verbal stimuli; however, she did not observe any evidence of automatism or tonic-clonic movements. There was no report of epilepsy in the patient's family history.Blood pressure on admission was 114/82 mmHg and heart rate was 72 bpm and regular. A general physical examination and detailed neurologic assessment, including orthostatic vital signs, were ...

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JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia

Takase,

Ikeda,

Shimizu

et al. 2024

Journal of Arrhythmia

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This article is to be co-published with Circulation Journal. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.This document is an English version of JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia reported at the 86th Annual Scientific Meeting of Japanese Circulation Society performed in 2022.

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Syncope and Ictal Asystole Caused by Temporal Lobe Epilepsy

Cited by 11 publications

References 16 publications

Long‐Term Follow‐Up of Ictal Asystole in Temporal Lobe Epilepsy: Is Permanent Pacemaker Therapy Needed?

Long‐Term Follow‐Up of Ictal Asystole in Temporal Lobe Epilepsy: Is Permanent Pacemaker Therapy Needed?

Subclinical Tonic-Clonic Epileptic Seizure Detected by an Implantable Loop Recorder

JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia

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