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Cardiac Asystole in Epilepsy: Clinical and Neurophysiologic Features
Open accessAbstract
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.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [415]
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“However, certain associated factors include focal temporal lobe onset (Ghearing et al. 2007; Strzelczyk et al. 2011), long-standing and refractory epilepsy (Rugg-Gunn et al. 2004), a prolonged post-ictal period (Rocamora et al. 2003), and ictal syncope (Bestawros et al. 2015).”
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“Hierbei könnten auch offene Fragen etwa hinsichtlich der Fokuslokalisation und des SUDEP-Risikos, der Effekte interiktaler Entladungen und der postoperativen Medikation, geklärt werden.”
BackgroundInfluentialSyncope vs. Seizure: Ictal Bradycardia and Ictal Asystole
Ouchida, S., Parratt, K. L., Nikpour, A., & Fairbrother, G. (2024) · Case Reports in Neurological Medicine · doi:10.1155/2024/1299282 · Cited by 2
“Ictal asystole (IA) is a rare condition found in 0.27–0.4% of patients undergoing video electroencephalography (EEG) monitoring [2, 3].”
BackgroundInfluentialSelected Medicines That Can Cause Cardiac Arrest with Asystole
Czarnecka, K., Jędrzejec, M., Kukiełczyńska, A., Owczarek, J., Olejnik, Ł., & Szymański, P. (2025) · Current Issues in Molecular Biology · doi:10.3390/cimb47050299 · Cited by 2
“Asystole is often caused by drug resistant epilepsy [1], infarct, loss of a large amount of blood, vagal overactivity, cardiac arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF), a defective pacemaker [2] and certain drugs such as beta-blockers and street drugs such…”
Chiang, C., Kotamraju, B. P., & Durand, D. M. (2025) · Epilepsia Open · doi:10.1002/epi4.70060 · Cited by 2
“3 Seizure-induced bradycardia and even asystole have been documented as determined by video-EEG monitoring periods, 12–14 although the long-term risk of ictal bradycardia in patients with intractable epilepsy is not known.”
Das EEG in der prächirurgischen Epilepsiediagnostik
Surges, R., Kurthen, M., & Elger, C. E. (2011) · Springer eBooks · doi:10.1007/978-3-642-19943-1_8 · Cited by 2
Ictal Cardiac Ryhthym Abnormalities
Ali, R. (2016) · The Open Cardiovascular Medicine Journal · doi:10.2174/1874192401610010105 · Cited by 2
“4% of patients undergoing diagnostic video-electroencephalogram recordings in epilepsy monitoring units (EMU) [1 - 3].”
Cardiac Asystole Triggered by Temporal Lobe Epilepsy with Amygdala Enlargement
Arakawa, J., Nagai, T., Takasaki, H., Sugano, H., Hamabe, A., Tahara, M., Mori, H., Takase, Y., Gatate, Y., Togashi, N., et al. (2016) · Internal Medicine · doi:10.2169/internalmedicine.55.6200 · Cited by 2
“Epilepsy-induced cardiac asystole, also termed “ictal asystole,” was previously described in patients with temporal lobe epilepsy (2, 3) and has been proposed as one of the potential mechanisms causing SUDEP (4).”
Background[Epileptic asystole - a case report].
Kukla, P., Jastrzębski, M., Czamara, M., Bryniarski, L., Przyprawa, A., & Bałajewicz, J. (2012) · PubMed · Cited by 2
Verma, I. (2016) · MOJ Clinical & Medical Case Reports · doi:10.15406/mojcr.2016.04.00107 · Cited by 2
Causes of sudden death in the young — Cardiac and non-cardiac
Lang, J., Pflaumer, A., & Davis, A. M. (2017) · Progress in Pediatric Cardiology · doi:10.1016/j.ppedcard.2017.02.007 · Cited by 2
Sudden Unexpected Death in Epilepsy
Rugg‐Gunn, F. J., & Nashef, L. A. M. (2009) · Blue books of neurology · doi:10.1016/b978-1-4160-6171-7.00015-7 · Cited by 2
Función reguladora del arco reflejo presorreceptor sobre la vía simpática descendente
Rafael, H. (2006) · Cited by 2
Role of Neuropeptides in the Production of Epileptogenic Activity and Arrhythmias
Lathers, C. M. (2010) · CRC Press eBooks · doi:10.1201/b10317-37 · Cited by 2
Cardiology perspective on seizure-related bradyarrhythmias and SUDEP: A survey study
Farrenburg, M., Rali, A. S., Grodzinsky, A., & Landazuri, P. (2021) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2021.108188 · Cited by 1
Iatrogenic bradycardia-asystole as a complication of an intracranial Ommaya reservoir
Arunachalam, R., Kennedy, C., & Kashyape, P. S. (2015) · Journal of Pediatric Neurology · doi:10.3233/jpn-130614 · Cited by 1
“4 % of patients with epilepsy [6].”
Sinha, S., Chaitanya, G., Subbareddy, S., Velmurugan, J., Arima, A., Rose, B., Mahadevan, A., Nagappa, M., Bindu, P., Rao, M., et al. (2014) · Annals of Indian Academy of Neurology · doi:10.4103/0972-2327.144279 · Cited by 1
Automatic seizure detection by ECG analysis
Burgess, R. C. (2003) · Handbook of clinical neurophysiology · doi:10.1016/s1567-4231(03)03013-2 · Cited by 1
Hoerth, M. T., Drazkowski, J. F., Noe, K. H., & Sirven, J. I. (2011) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2011.03.035 · Cited by 1
“Despite the low incidence of loss of spontaneous circulation with seizures, seizures are oftenperceived bywitnesses tobe life-threatening [1,2].”
BackgroundSudden Unexpected Death in Epilepsy: What Does Sleep Have to Do With It?
Grigg-Damberger, M. M. (2012) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2012.01.004 · Cited by 1
Wook, S. J., 백인철, 오지은, Rhee, K., 정혜선, & Kim, J. M. (2011) · Journal of the Korean Neurological Association · Cited by 1
An unusual case of loss of consciousness: when an epileptic brain let the heart slow down
Assenza, G., Assenza, F., Pellegrino, G., & Tombini, M. (2012) · Clinical Management Issues · doi:10.7175/cmi.v6i1.620 · Cited by 1
Zaburzenia czynności układu autonomicznego u chorych na padaczkę
Mariańska, K. (2008) · Via Medica Journals · Cited by 1
Metadata
- 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 › Clinical Neurology › 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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