Ictal asystole with convulsive syncope mimicking secondary generalisation: a depth electrode study.
Details
Serval ID
serval:BIB_2E89482A7288
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Ictal asystole with convulsive syncope mimicking secondary generalisation: a depth electrode study.
Journal
Journal of Neurology, Neurosurgery, and Psychiatry
ISSN
0022-3050
Publication state
Published
Issued date
2005
Peer-reviewed
Oui
Volume
76
Number
6
Pages
885-887
Language
english
Notes
Publication types: Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
Abstract
Ictal bradycardia is rare and its localising value is debated. Bradyarrhythmias are, however, important because of their potential connection to sudden death and ability to affect clinical seizure manifestations. Cerebral hypoperfusion induces loss of consciousness, at times with myoclonic jerks, whose clinical differentiation from a generalised convulsive seizure may prove difficult.Two invasive and five surface monitored seizures recorded over two years in a 51 year old woman with post-traumatic epilepsy characterised by seizure-triggered asystole were analysed. All seven seizures showed left temporal onset. Both intracranially recorded events started in the left anterior hippocampus/amygdala, spreading to the contralateral hippocampus in 35 and 25 seconds. Within 10 seconds an electrocardiogram showed asystole lasting 21 and 28 seconds, associated with suppression of recorded cerebral electrical activity, except a polyspike suppression pattern remaining in the hippocampi. Clinically, the patient, concomitantly with the cerebral suppression, developed myoclonic twitches of the limbs. A dual chamber cardiac pacemaker was implanted; at 11 months follow up, the patient has experienced only infrequent partial seizures, with none involving falls or shaking.Left temporal lobe seizures produced convulsive syncope initiated by ictal asystole. These observations suggest that intertemporal spread is necessary, though not sufficient, to produce bradycardia and asystole. Furthermore, pacemakers may decrease seizure severity, as well as potentially protect against malignant bradyarrhythmias.
Keywords
Amygdala, Brain Injuries, Diagnosis, Differential, Electrodes, Implanted, Epilepsy, Generalized, Female, Follow-Up Studies, Heart Arrest, Hippocampus, Humans, Middle Aged, Pacemaker, Artificial, Syncope
Pubmed
Web of science
Open Access
Yes
Create date
14/05/2009 7:06
Last modification date
20/08/2019 13:13