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Published on: March 27, 2021
Clinical cues for detecting ictal asystole
Gena R Ghearing1, Thomas M Munger, Allan S Jaffe
1Dept. of Neurology, Mayo Clinic Rochester, Rochester, MN 55905, USA.
Summary
Ictal asystole, a dramatic seizure event, can be detected by specific clinical signs like limb jerking or loss of muscle tone. Early recognition aids in necessary treatment for epilepsy patients experiencing these events.
Area of Science:
- Epilepsy and Neurology
- Cardiology and Cardiac Electrophysiology
Background:
- Ictal asystole, a rare but critical event, represents the most severe form of ictal bradycardia during epileptic seizures.
- Accurate identification of ictal asystole is crucial for timely and appropriate management, potentially involving antiepileptic drugs and cardiac pacing.
Purpose of the Study:
- To identify specific clinical indicators that can help in the early detection of ictal asystole during epileptic seizures.
Main Methods:
- Analysis of clinical and electrophysiologic data from prolonged video-electroencephalography (EEG)/electrocardiography (ECG) monitoring.
- Inclusion of consecutive patients diagnosed with ictal bradycardia and asystole over a 14-year period.
Main Results:
- Eleven seizures with ictal asystole were identified in seven patients out of 29 seizures with ictal bradycardia.
- Bilateral, asymmetric limb movements (posturing or jerking) and loss of muscle tone were observed in seizures with ictal asystole, but not in non-asystolic seizures.
- Patients with ictal asystole reported a history of seizure-related falls and brief body/limb jerking.
Conclusions:
- The presence of loss of muscle tone or bilateral asymmetric jerky limb movements during a seizure strongly suggests the possibility of ictal asystole.
- Video-EEG/ECG monitoring is recommended for epilepsy patients exhibiting these clinical features to confirm the presence of ictal asystole.
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