Cardiac asystole during a cluster of right temporo-parietal seizures

Ictal bradycardia and asystole can appear during an epileptic seizure. They must be promptly recognized and treated due to their potential life threatening consequences. Indeed, they have been implicated in the pathogenesis of sudden unexpected death in epilepsy (SUDEP). We report the case of a 33 year-old woman with a right temporo-parietal lobe epilepsy who presented a 19 s asystole during a cluster of seizures. Careful interview revealed appearance of numerous episodes of fall in the previous years. The patient underwent cardiological investigations including echocardiography and His bundle electrography that resulted to be normal. A pacemaker was immediately implanted and, although she continued presenting seizures, no more episodes of falls occurred. In order to better preview ictal asystole several risk factors need to be searched. Attention should be paid to an accurate medical history (ask for episodes of falls) and a simultaneous ECG/EEG recording. The occurrence of bradycardia during a seizure should lead to further cardiological investigations. This could help preventing the occurrence of dramatic consequences such as traumatic falls or SUDEP. (C) 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.