Cardiac asystole in epilepsy: clinical and neurophysiologic features
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PURPOSE: Cardiac asystole provoked by epileptic seizures is a rare but important complication in epilepsy and is supposed to be relevant to the pathogenesis of sudden unexplained death in epilepsy (SUDEP). We sought to determine the frequency of this complication in a population of patients with medically intractable epilepsy and to analyze the correlation between EEG, electrocardiogram (ECG), and clinical features obtained from long-term video-EEG monitoring. METHODS: Retrospective analysis of the clinical records of hospitalized patients from May 1992 to June 2001 who underwent long-term video-/EEG monitoring. RESULTS: Of a total of 1,244 patients, five patients had cardiac asystole in the course of ictal events. In these patients, 11 asystolic events, between 4 and 60 s long in a total of 19 seizures, were registered. All seizures had a focal origin with simple partial seizures (n = 13), complex partial seizures (n = 4), and secondarily generalized seizures (n = 2). One patient showed the longest asystole ever reported (60 s) because of a seizure. Cardiac asystole occurred in two patients with left-sided temporal lobe epilepsy (TLE) and in three patients with frontal lobe epilepsy (FLE; two left-sided, one bifrontal). Two patients reported previous cardiac disease, but only one had a pathologic ECG by the time of admission. Two patients had a simultaneous central ictal apnea during the asystole. None of the patients had ongoing deficits due to the asystole. CONCLUSIONS: These findings confirm that seizure-induced asystole is a rare complication. The event appeared only in focal epilepsies (frontal and temporal) with a lateralization to the left side. A newly diagnosed or known cardiac disorder could be a risk factor for ictal asystole. Abnormally long postictal periods with altered consciousness might point to reduced cerebral perfusion during the event because of ictal asystole. Central ictal apnea could be a frequent associated phenomenon.
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Epileptic asystole occurs in only a fraction of the seizures of one person, and then occurs after a variable interval of 5-100 s from seizure onset.
“Epileptic asystole occurs in only a fraction of the seizures of one person, and then occurs after a variable interval of 5-100 s from seizure onset.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [415]
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- Authors
- Rocamora, R., Kurthen, M., Lickfett, L., Von Oertzen, J., & Elger, C. E.
- Affiliations
- University of Bonn (DE)
- Corresponding author
- Rocamora, R.
- Venue
- Epilepsia
- Publisher
- Wiley
- Published
- 2003-02
- Volume
- 44
- Issue
- 2
- Pages
- 179-185
- ISSN
- 0013-9580 (ISSN-L)
- 1528-1167
- OpenAlex
- W2047214248
- Cited by
- 271
- References
- 30
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 7 · 2021: 11 · 2020: 5 · 2019: 10 · 2018: 17 · 2017: 13 · 2016: 13 · 2015: 15 · 2014: 15 · 2013: 12 · 2012: 10
- FWCI
- 7.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epilepsia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- asystole, sudden unexpected death in epilepsy, drug-resistant epilepsy, focal epilepsy, temporal lobe epilepsy, frontal lobe epilepsy, postictal state, cerebral perfusion, video-EEG monitoring
- MeSH terms
- Adolescent, Adult, Chronic Disease, Electrocardiography, Electroencephalography, Epilepsies, Partial, Epilepsy, Generalized, Epilepsy, Temporal Lobe, Evoked Potentials, Female, Follow-Up Studies, Heart Arrest, Humans, Male, Middle Aged, Monitoring, Physiologic, Retrospective Studies, Risk Factors, Signal Processing, Computer-Assisted, Video Recording, Epilepsy, Complex Partial, Epilepsy, Frontal Lobe
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