Abstracts

Rationale: The aim of the study is to clarify clinical characteristics of ictal asystole. Methods: We searched the patients who had the diagnosis of ictal asystole in 900 consecutive patients who attended the epilepsy center at our institution. The diagnostic criteria for the ictal asystole is confirmation of the ictal cardiac arrest by video/EEG monitoring and/or long term implanted loop recorder for heart beat. Results: There were three patients identified. Thus, the prevalence of the ictal asystole was 0.3% in patients with epilepsy. All had temporal lobe epilepsy. Patient 1 is 36 year-old man who underwent cardiac pacemaker implantation for syncope. After the failure of the complete control of the syncope, EEG recording revealed temporal lobe epilepsy. Patient 2 is a 80 year-old woman who has been treated for temporal lobe epilepsy for 15 years. Video/EEG monitoring was conducted for her intractable epilepsy, which revealed ictal bradycardia/asystole. Implantation of the cardiac pacemaker did not abolish the loss of consciousness as the complex partial seizure persisted. Patient 3 is 72 year-old man who underwent ECG with implantable loop recorder for his syncope. Asymptomatic frequent nocturnal cardiac arrest triggered the cardiologist to suspect the presence of epilepsy. EEG showed frequent temporal spikes and treatment with carbamazepine completely abolished the asystole and symptoms.Conclusions: The ictal asystole in temporal lobe epilepsy is rare. The prevalence was 0.3% in patients with epilepsy. The diagnosis is often delayed. The clinical presentation could be syncope or complex partial seizures.