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Maria Dons1, Mathias Due Buron2, Julie Maria Hejgaard Laursen2

  • 1Hjerteafdeling Y, Københavns Universitetshospital - Bispebjerg og Frederiksberg Hospital.

Ugeskrift for Laeger
|November 13, 2024
PubMed
Summary

Ictal bradyarrhythmia and ictal asystole are rare epilepsy complications. This case report details a patient experiencing ictal asystole, highlighting treatment focused on seizure reduction and fall prevention.

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Area of Science:

  • Neurology
  • Cardiology

Background:

  • Ictal bradyarrhythmia (IB) and ictal asystole (IA) are infrequent but serious complications associated with epileptic seizures.
  • The precise mechanisms linking seizures to cardiac autonomic dysfunction, particularly parasympathetic overactivity, are under investigation.

Observation:

  • This report describes a 68-year-old woman with mesial temporal lobe epilepsy and hippocampal sclerosis who experienced ictal asystole.
  • The patient's presentation involved a rare occurrence of asystole during a seizure, leading to cerebral hypoxemia.

Findings:

  • The onset latency of IB/IA suggests involvement of central parasympathetic pathways.
  • While IA can terminate seizures, its association with sudden unexpected death in epilepsy (SUDEP) remains unproven.
  • Pacemaker implantation is rarely indicated for this condition.

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Implications:

  • Management strategies should prioritize minimizing seizure frequency and severity.
  • Reducing the risk of falls in patients with epilepsy and associated cardiac events is crucial.
  • Further research is needed to elucidate the pathophysiology and long-term outcomes of IA.