Video-electrographic and clinical features in patients with ictal asystole

Neurology. 2007 Jul 31;69(5):434-41. doi: 10.1212/01.wnl.0000266595.77885.7f.


Objective: Ictal asystole (IA) is a rare event mostly seen in patients with temporal lobe epilepsy (TLE) and a potential contributor to sudden unexplained death in epilepsy (SUDEP). Clinical and video-electroencephalographic findings associated with IA have not been described, and may be helpful in screening for high risk patients.

Methods: A database search was performed of 6,825 patients undergoing long-term video-EEG monitoring for episodes of IA.

Results: IA was recorded in 0.27% of all patients with epilepsy, eight with temporal (TLE), two with extratemporal (XTLE), and none with generalized epilepsy. In 8 out of 16 recorded events, all occurring in patients with TLE, seizures were associated with a sudden atonia on average 42 seconds into the typical semiology of a complex partial seizure. The loss of tone followed after a period of asystole usually lasting longer than 8 seconds and was associated with typical EEG changes seen otherwise with cerebral hypoperfusion. Clinical predisposing factors for IA including cardiovascular risk factors or baseline ECG abnormalities were not identified.

Conclusion: Ictal asystole is a rare feature of patients with focal epilepsy. Delayed loss of tone is distinctly uncommon in patients with temporal lobe seizures, but may inevitably occur in patients with ictal asystole after a critical duration of cardiac arrest and cerebral hypoperfusion. Further cardiac monitoring in patients with temporal lobe epilepsy and a history of unexpected collapse and falls late in the course of a typical seizure may be warranted and can potentially help to prevent sudden unexplained death in epilepsy.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Autonomic Pathways / physiopathology
  • Bradycardia / diagnosis
  • Bradycardia / etiology
  • Bradycardia / physiopathology
  • Brain / anatomy & histology
  • Brain / physiopathology
  • Brain Ischemia / diagnosis
  • Brain Ischemia / etiology
  • Brain Ischemia / physiopathology
  • Child, Preschool
  • Death, Sudden, Cardiac / etiology*
  • Death, Sudden, Cardiac / prevention & control
  • Early Diagnosis
  • Electrodiagnosis / methods*
  • Electrodiagnosis / standards
  • Electrodiagnosis / trends
  • Electroencephalography / methods
  • Electroencephalography / standards
  • Electroencephalography / trends
  • Epilepsy / complications*
  • Epilepsy / diagnosis
  • Epilepsy / physiopathology
  • Epilepsy, Generalized / etiology
  • Epilepsy, Generalized / physiopathology
  • Epilepsy, Temporal Lobe / complications*
  • Epilepsy, Temporal Lobe / diagnosis
  • Epilepsy, Temporal Lobe / physiopathology
  • Female
  • Heart Arrest / diagnosis
  • Heart Arrest / etiology*
  • Heart Arrest / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic / instrumentation
  • Monitoring, Physiologic / methods
  • Monitoring, Physiologic / standards
  • Predictive Value of Tests
  • Syncope / diagnosis
  • Syncope / etiology
  • Syncope / physiopathology
  • Video Recording / methods
  • Video Recording / standards
  • Video Recording / trends