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The ictal bradycardia syndrome
A L Reeves1, K E Nollet, D W Klass
1Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Epilepsia
|October 1, 1996
Summary
The ictal bradycardia syndrome, a cause of syncope during seizures, often indicates temporal lobe epilepsy onset. This condition is more common in males and may require pacemakers and antiepileptic drugs.
Area of Science:
- Neurology
- Cardiology
- Epileptology
Background:
- Episodic loss of consciousness poses diagnostic challenges.
- The ictal bradycardia syndrome, characterized by epileptic discharges disrupting cardiac rhythm, causes cardiogenic syncope.
- This syndrome is an underrecognized cause of syncope.
Observation:
- A review of 27 cases (23 from literature, 4 new) was conducted.
- Patient demographics including age, sex, and seizure onset site were analyzed.
- The ictal bradycardia syndrome affects patients from 4 months to 72 years, with a mean age of 39.
Findings:
- The syndrome predominantly affects males (5:1 ratio).
- Seizure onset was localized to the temporal lobe in 87% of cases with identifiable onset sites.
- No clear lateralizing predominance within the temporal lobe was observed.
Implications:
- The ictal bradycardia syndrome suggests temporal lobe seizure onset and is more prevalent in males.
- Consider this syndrome in patients with refractory syncope or a history of both epilepsy and syncope.
- Diagnosis can be aided by ambulatory EEG/ECG monitoring; treatment may involve pacemakers and antiepileptic drugs to prevent mortality.