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Updated: Oct 3, 2025

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Iatrogenic ictal asystole.

Elena Pasini1, Patrizia Riguzzi1, Roberto Michelucci1

  • 1IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.

Journal of the Neurological Sciences
|February 13, 2022
PubMed
Summary
This summary is machine-generated.

Sodium channel blockers like carbamazepine and phenytoin may cause ictal asystole in focal epilepsy patients. This rare cardiac event, linked to these epilepsy drugs, requires careful consideration in treatment algorithms.

Keywords:
ArrhythmiaCarbamazepineEpilepsyFaintPhenytoin

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Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Sodium channel blockers are standard treatments for focal epilepsies.
  • Cardiac conduction effects of these drugs are rarely considered.
  • Ictal asystole is a rare but serious seizure complication with unclear causes.

Observation:

  • Two cases of focal pharmacoresistant epilepsy presented with ictal asystole.
  • Ictal asystole occurred exclusively during treatment with carbamazepine and phenytoin.
  • These antiepileptic drugs are known sodium channel blockers.

Findings:

  • A potential link exists between sodium channel blockers and ictal asystole.
  • Negative chronotropic and inotropic cardiac effects may mediate this association.
  • Ictal asystole can worsen fall risk in epilepsy patients.

Implications:

  • Iatrogenic causes of ictal asystole should be integrated into treatment protocols.
  • Prompt therapeutic decisions are crucial for managing ictal asystole.
  • Further research is needed to elucidate the precise mechanisms.