Heart versus brain: a case of ictal asystole in temporal lobe epilepsy
Tóm tắt
Ictal asystole is a rare phenomenon. Most reported cases are in persons with long-standing focal epilepsy originating from the temporal lobe. Its occurrence may complicate the clinical presentation or delay diagnosis, and it is thought to be associated with increased risk of sudden unexpected death in epilepsy. We report the case of a 55-year-old female person with epilepsy who suffered ictal asystole for 10 s while under monitoring at the Epilepsy Monitoring Unit. We then review briefly the pathophysiology and current management modalities for this phenomenon. The first step in management of this condition is usually the optimization of anti-seizure drugs. In our case, a 2-year fall-free period was achieved with optimization of medical treatment. Pacemaker implantation can also be attempted to prevent ictal asystole-related falls and injury, while refractory cases may benefit from epilepsy surgery in terms of both seizure control and prevention of ictal asystole.
Tài liệu tham khảo
Keilson MJ, Hauser WA, Magrill JP. Electrocardiographic changes during electrographic seizures. Arch Neurol. 1989;46(11):1169–70.
Benditt DG, van Dijk G, Thijs RD. Ictal asystole: life-threatening vagal storm or a benign seizure self-termination mechanism? Circ Arrhythm Electrophysiol. 2015;8(1):11–4.
Rocamora R, Kurthen M, Lickfett L, Von Oertzen J, Elger CE. Cardiac asystole in epilepsy: clinical and neurophysiologic features. Epilepsia. 2003;44(2):179–85.
Schuele SU, Bermeo AC, Alexopoulos AV, Locatelli ER, Burgess RC, Dinner DS, et al. Video-electrographic and clinical features in patients with ictal asystole. Neurology. 2007;69(5):434–41.
Strzelczyk A, Cenusa M, Bauer S, Hamer HM, Mothersill IW, Grunwald T, et al. Management and long-term outcome in patients presenting with ictal asystole or bradycardia. Epilepsia. 2011;52(6):1160–7.
Rossetti AO, Dworetzky BA, Madsen JR, Golub O, Beckman JA, Bromfield EB. Ictal asystole with convulsive syncope mimicking secondary generalisation: a depth electrode study. J Neurol Neurosurg Psychiatry. 2005;76(6):885–7.
Al-Awwad AA, Katyal R, Herren CL. Ictal Asystole in temporal lobe epilepsy: a possible cause of sudden unexplained death - a case report. Neurodiagn J. 2018;58(4):213–7.
Langan Y, Nashef L, Sander JW. Sudden unexpected death in epilepsy: a series of witnessed deaths. J Neurol Neurosurg Psychiatry. 2000;68(2):211–3.
Sanchez-Borque P, Gonzalez-Giraldez B, Benezet-Mazuecos J, Miracle A, Crosa J, Rubio JM. Ictal asystole: a condition between neurology and cardiology. Int J Cardiol. 2019;278:104–7.
van Westrhenen A, Thijs RD. Ictal asystole: how to unveil the hidden ties between the brain and the heart. Int J Cardiol. 2019;278:147–8.
Tinuper P, Bisulli F, Cerullo A, Carcangiu R, Marini C, Pierangeli G, et al. Ictal bradycardia in partial epileptic seizures: autonomic investigation in three cases and literature review. Brain. 2001;124(Pt 12):2361–71.
van der Lende M, Surges R, Sander JW, Thijs RD. Cardiac arrhythmias during or after epileptic seizures. J Neurol Neurosurg Psychiatry. 2016;87(1):69–74.
Tenyi D, Gyimesi C, Kupo P, Horvath R, Bone B, Barsi P, et al. Ictal asystole: a systematic review. Epilepsia. 2017;58(3):356–62.
Choudhary N, Deepak KK, Chandra PS, Bhatia S, Sagar R, Jaryal AK, et al. Comparison of autonomic function before and after surgical intervention in patients with temporal lobe epilepsy. J Epilepsy Res. 2017;7(2):89–98.
Oppenheimer SM, Wilson JX, Guiraudon C, Cechetto DF. Insular cortex stimulation produces lethal cardiac arrhythmias: a mechanism of sudden death? Brain Res. 1991;550(1):115–21.
Catenoix H, Mauguiere F, Guenot M, Isnard J, Ryvlin P. Recording the insula during ictal asystole. Int J Cardiol. 2013;169(2):e28–30.
Healy B, Peck J. Bradycardia induced from stimulation of the left versus right central nucleus of the amygdala. Epilepsy Res. 1997;28(2):101–4.
Bestawros M, Darbar D, Arain A, Abou-Khalil B, Plummer D, Dupont WD, et al. Ictal asystole and ictal syncope: insights into clinical management. Circ Arrhythm Electrophysiol. 2015;8(1):159–64.
Kohno R, Abe H, Akamatsu N, Benditt DG. Long-term follow-up of Ictal Asystole in temporal lobe epilepsy: is permanent pacemaker therapy needed? J Cardiovasc Electrophysiol. 2016;27(8):930–6.
Ichikawa N, Fujimoto A, Okanishi T, Sato K, Baba S, Itamura S, et al. Ictal Asystole induced by right posterior quadrant epilepsy: report of a radically treated case. World Neurosurg. 2018;120:337–42.
Ballendine S, Shahab I, Perez-Careta M, Taveras-Almonte FJ, Martinez-Juarez IE, Hernandez-Vanegas LE, et al. Resolution of ictal bradycardia and asystole following temporal lobectomy: a case report, and review of available cases using pacemakers. Epilepsy Behav Rep. 2019;12:100333.