The DOI matches its Crossref record; 49 of the 49 references it cites were found in a registry or an index.
Video-electrographic and clinical features in patients with ictal asystole
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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
Proposal for Revised Clinical and Electroencephalographic Classification of Epileptic Seizures
(1981) · Epilepsia · doi:10.1111/j.1528-1157.1981.tb06159.x · Cited by 3,433
Cardiovascular effects of human insular cortex stimulation
Oppenheimer, S. M., Gelb, A., Girvin, J. P., & Hachinski, V. C. (1992) · Neurology · doi:10.1212/wnl.42.9.1727 · Cited by 1,272
Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia.
Lempert, T., Bauer, M., & Schmidt, D. (1994) · Annals of Neurology · doi:10.1002/ana.410360217 · Cited by 452
Cardiac arrhythmias in focal epilepsy: a prospective long-term study
Rugg-Gunn, F. J., Simister, R. J., Squirrell, M., Holdright, D. R., & Duncan, J. S. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17594-6 · Cited by 384
ACUTE ARREST OF CEREBRAL CIRCULATION IN MAN
Kabat, H. (1943) · Archives of Neurology And Psychiatry · doi:10.1001/archneurpsyc.1943.02290230022002 · Cited by 371
Medullary regions mediating atonia
Lai, Y., & Siegel, J. (1988) · Journal of Neuroscience · doi:10.1523/jneurosci.08-12-04790.1988 · Cited by 365
Apnoea and bradycardia during epileptic seizures: relation to sudden death in epilepsy.
Nashef, L. A. M., Walker, F., Allen, P. J., Sander, J. W. A. S., Shorvon, S. D., & Fish, D. R. (1996) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.60.3.297 · Cited by 363
Electrocardiographic Changes at the Onset of Epileptic Seizures
Leutmezer, F., Schernthaner, C., Lurger, S., Pötzelberger, K., & Baumgartner, C. (2003) · Epilepsia · doi:10.1046/j.1528-1157.2003.34702.x · Cited by 314
Insular cortex stimulation produces lethal cardiac arrhythmias: a mechanism of sudden death?
Oppenheimer, S. M., Wilson, J. X., Guiraudon, C., & Cechetto, D. F. (1991) · Brain Research · doi:10.1016/0006-8993(91)90412-o · Cited by 298
EKG Abnormalities During Partial Seizures in Refractory Epilepsy
Nei, M., Ho, R. T., & Sperling, M. R. (2000) · Epilepsia · doi:10.1111/j.1528-1157.2000.tb00207.x · Cited by 276
Cited by
Sorted by citations
2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.044 · Cited by 1,008
Sudden unexpected death in epilepsy: current knowledge and future directions
Tomson, T., Nashef, L. A. M., & Ryvlin, P. (2008) · The Lancet Neurology · doi:10.1016/s1474-4422(08)70202-3 · Cited by 673
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000628 · Cited by 603
Sudden unexpected death in epilepsy
Shorvon, S. D., & Tomson, T. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60176-1 · Cited by 510
Metadata
- 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.
- Venue
- Neurology
- Published
- 2007-07-31
- Volume
- 69
- Issue
- 5
- Pages
- 434-441
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- 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 › Clinical Neurology › Epilepsy research and treatment
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Clinical Neurology › 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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