Clinical cues for detecting ictal asystole
Open accessAbstract
OBJECTIVE: The occurrence of asystole during an epileptic seizure is the most dramatic manifestation of ictal bradycardia. Recognition of ictal asystole is important as treatment with both antiepileptic drugs and cardiac pacing may be necessary. The purpose of this study was to identify clinical cues to aid in the detection of ictal asystole. METHODS: We analyzed the clinical and electrophysiologic features of all recorded seizures in consecutive patients diagnosed with ictal bradycardia and asystole on prolonged video-EEG/ECG monitoring over a 14 year period. RESULTS: Twenty-nine seizures with ictal bradycardia were identified in 13 patients. Of these, 11 seizures in seven patients were associated with asystole. Bilateral transient limb movements consisting of asymmetric posturing or jerking occurred during eight episodes of ictal asystole, and loss of muscle tone occurred during four. In contrast, neither bilateral limb movement nor loss of muscle tone was observed in any of the non-asystolic seizures, whether ictal bradycardia was present or not. All patients with ictal asystole reported a history of seizure-related falls and brief body and limb jerking. CONCLUSIONS: The presence of loss of muscle tone or bilateral asymmetric jerky limb movements during a seizure suggests the possibility of ictal asystole. Video-EEG/ECG monitoring should be considered in patients with epilepsy demonstrating these clinical features to determine if ictal asystole is present.
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A typical history is for a partial complex seizure to progress as usual for that patient, and then the patient suddenly falls flaccidly, with or without brief myoclonic jerking.
“A typical history is for a partial complex seizure to progress as usual for that patient, and then the patient suddenly falls flaccidly, with or without brief myoclonic jerking.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [417]
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2018 ESC Guidelines for the diagnosis and management of syncope
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- Authors
- Ghearing, G. R., Munger, T. M., Jaffe, A. S., Benarroch, E. E., & Britton, J. W.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Britton, Jeffrey W.
- Venue
- Clinical Autonomic Research
- Published
- 2007-06
- Volume
- 17
- Issue
- 4
- Pages
- 221-226
- ISSN
- 0959-9851 (ISSN-L)
- 1619-1560
- OpenAlex
- W2061420794
- Cited by
- 57
- References
- 21
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2022: 2 · 2021: 4 · 2020: 2 · 2019: 3 · 2018: 8 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 5 · 2013: 4 · 2012: 1
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Autonomic Research (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- ictal asystole, ictal bradycardia, epilepsy
- MeSH terms
- Adolescent, Adult, Aged, Bradycardia, Electrocardiography, Electroencephalography, Epilepsy, Extremities, Female, Heart Arrest, Humans, Middle Aged, Movement, Muscle Tonus, Videotape Recording
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