Abstracts

Rationale: Ictal bradycardia-asystole (IBA) is a potential contributor to sudden death in some patients with temporal lobe epilepsy (TLE). It has been suggested that ictal atonia and left-sided TLE are associated with IBA. Screening of high-risk patients and preventive treatment may save the lives of TLE patients who are at risk for cardiac arrest. We noticed that autonomic aura occurs more frequently in our TLE patients with IBA than other TLE patients. Methods: An EEG-Video Monitoring database search from April 2004 until December 2010 at University of Manitoba was performed to identify patients with TLE who had ictal IBA. All patients had 10-20 system scalp EEG-Video recording and single-channel ECG. We defined Ictal bradycardia as a heart rate (HR) less than 60/m or a HR drop of more than 10% from baseline, lasting for at least 10 seconds. Ictal asystole was defined as an R-R interval of >3.0s, which lasted for at least twice the duration of the preceding R-R interval. Results: We identified 120 patients with TLE. Six patients with both TLE and IBA were identified. Four of those patients (66%) reported autonomic aura prior to their seizures whereas only 33 out of 112 (29%) patients with TLE but not IBA reported autonomic aura. Two patients with IBA had ictal atonia (33%) followed by generalized jerking wheras only one patient without IBA had ictal atonia (0.9 %). Seizure generators were localized to the left side in four (66%) and to the right side in two (33%) of the TLE patients with IBA.Conclusions: Our study supports the previous suggestions that ictal atonia and left sided seizure generator in TLE patients with IBA proportionally more than those without IBA. Furthermore we found that patients with TLE and autonomic auras may have higher risk for IBA.