Video-electrographic and clinical features in patients with ictal asystole

Schuele, S. U.; Bermeo, A. C.; Alexopoulos, A. V.; Locatelli, E. R.; Burgess, R. C.; Dinner, D. S.; Foldvary-Schaefer, N.

doi:10.1212/01.wnl.0000266595.77885.7f

Cited by 261Epilepsy research and treatmentCardiac Arrest and ResuscitationNeurological and metabolic disorders

Video-electrographic and clinical features in patients with ictal asystole

Schuele, S. U., Bermeo, A. C., Alexopoulos, A. V., Locatelli, E. R., Burgess, R. C., Dinner, D. S., Foldvary-Schaefer, N.·2007·Neurology

DOI 10.1212/01.wnl.0000266595.77885.7f

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Abstract

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.

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If asystole lasts for more than about 8 s, syncope ensues.
“If asystole lasts for more than about 8 s, syncope ensues.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [416]
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 [416]
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 [416]

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Authors: Schuele, S. U., Bermeo, A. C., Alexopoulos, A. V., Locatelli, E. R., Burgess, R. C., Dinner, D. S., & Foldvary-Schaefer, N.
Affiliations: Northwestern University (US)
From Cleveland Clinic (S.U.S., A.C.B., A.V.A., E.R.L., R.C.B., D.S.D., N.F.-S.), OH; and Northwestern University (S.U.S.), Chicago, IL.
ORCID: Schuele, S. U.
Alexopoulos, A. V.
Burgess, R. C.
Venue: Neurology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2007-07-31
Volume: 69
Issue: 5
Pages: 434-441
ISSN: 0028-3878 (ISSN-L)
1526-632X
DOI: 10.1212/01.wnl.0000266595.77885.7f
OpenAlex: W1980960280
Cited by: 261
References: 49
Citations by year: 2026: 6 · 2025: 8 · 2024: 12 · 2023: 6 · 2022: 10 · 2021: 16 · 2020: 8 · 2019: 18 · 2018: 24 · 2017: 14 · 2016: 11 · 2015: 18 · 2014: 12 · 2013: 12 · 2012: 15
FWCI: 9.89
Type: journal article
Language: en
Open access: closed
Locations: Neurology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
Keywords: ictal asystole, temporal lobe epilepsy, sudden unexpected death in epilepsy, cerebral hypoperfusion, complex partial seizures, seizure semiology, extratemporal epilepsy, cardiac monitoring, video-EEG monitoring
MeSH terms: Adolescent, Adult, Aged, Bradycardia, Brain, Brain Ischemia, Child, Preschool, Electrodiagnosis, Electroencephalography, Epilepsy, Epilepsy, Generalized, Epilepsy, Temporal Lobe, Female, Heart Arrest, Humans, Male, Middle Aged, Monitoring, Physiologic, Predictive Value of Tests, Syncope, Video Recording, Death, Sudden, Cardiac, Autonomic Pathways, Early Diagnosis

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Video-electrographic and clinical features in patients with ictal asystole

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