Ictal asystole: case report with review of literature

Cardiac arrhythmias are frequently observed during epileptic seizures. Mostly they are benign, but severe bradycardia and asystole occur in 0.27-0.5% of patients who have seizures on video-EEG monitoring units. Especially patients with partial seizures involving the insular, orbital frontal and anterior temporal lobe regions, are at risk. Ictal bradycardia could be a cause of SUDEP (sudden unexpected death in epilepsy) and pacemaker insertion might therefore improve survival in selected cases, although more research is needed to prove this. We present a case of prolonged ictal asystole in a patient with newly diagnosed partial epilepsy originating from the temporal lobe.