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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 69, Number 05, July 31, 2007 Video Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schuele, S. U. Articles by Foldvary-Schaefer, N. Search for Related Content PubMed PubMed Citation Articles by Schuele, S. U. Articles by Foldvary-Schaefer, N. Related Collections Autonomic diseases Syncope Epilepsy semiology Video/ EEG use in epilepsy Related Article

Video-electrographic and clinical features in patients with ictal asystole

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.

Address correspondence and reprint requests to Dr. Stephan U. Schuele, Northwestern University, Department of Neurology, Abbott Hall # 1122, 710 North Lake Shore Drive, Chicago, IL 60611 s-schuele{at}northwestern.edu

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.

Editorial, see page 423

Supplemental data at www.neurology.org

Disclosure: The authors report no conflicts of interest.

Received October 6, 2006. Accepted in final form March 21, 2007.

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Ictal asystole and SUDEP

Norman K. So and Michael R. Sperling
Neurology 2007 69: 423-424. [Full Text] [PDF]

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