BACKROUND: Ictal asystole (IA) has been primarily reported in the literature through small
series, case reports and meta-analyses of the former, without comparison to controls.
METHODS : In this multicentric study, we collected the largest series of 102 patients with IA
diagnosed during video-EEG monitoring (VEEG), and compared their clinical characteristics
to those of 201 controls who underwent VEEG in the same centers around the same date.
FINDINGS : The mean age at onset of epilepsy and at time of recorded IA/event were
significantly older (p value <0.0001) in IA cases (25.5 and 43.4 years, respectively) than in
controls (15.4 and 33.4, respectively). A temporal lobe involvement and a temporal lobe
seizure onset in the absence of mesial temporal sclerosis were also significantly more frequent
in patients with IA than in controls (p value of 0.036 and 0.010, respectively). Conversely, the
duration of epilepsy, gender and lateralization of the epileptogenic zone did not differ between
the two groups. A pacemaker was implanted in 53% of IA patients, reducing the number of
ictal falls in 43% of them.
CONCLUSION : IA appears to be promoted by older age and older age at onset. Epilepsies
involving the temporal lobe are at higher risk of IA than other forms of epilepsy, in particular
temporal lobe epilepsy without mesial temporal sclerosis. No other risk factor of AI was
identified. A pacemaker can reduce or abolish ictal falls in some patients.