Asystole induced by electrical stimulation of the left cingulate gyrus

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Leung H, Schindler K, Kwan P, and Elger C (2007) Asystole induced by electrical stimulation of the left cingulate gyrus. Epileptic Disord 9:1 77–81.

Link to Article

Abstract: The cortical control of the autonomic system may account for the clinical phenomenon of ictal asystole which, in turn, has been speculated to be a potential mechanism for sudden unexpected death in epilepsy (SUDEP). We report an 18-year-old patient with frontal lobe epilepsy who had intracranial electrode placement showing bifrontal seizure-onset. This patient received electrical stimulation to the left cingulate gyrus and developed cardiac asystole within 3 seconds of electrical stimulation. Intracranial monitoring showed epileptiform discharges in the left frontal polar, frontal lateral and interhemispheric electrodes. We suggest that the left cingulate gyrus, as part of the central autonomic network, may mediate bradyarrhythmia through the vagal pathway. There remains the possibility that other brain regions were also involved due to the time lag between asystole and epileptiform discharges, and the lack of intracranial exploration in the mesial temporal and insular regions. [Published with video sequences].

Keywords: cardiac asystole, cingulate gyrus, SUDEP, frontal lobe epilepsy

Context

  • Single case report of bradycardia induced by electrical stimulation of the left cingulate in a patient undergoing surgical treatment for intractable epilepsy. The stimulation triggered the subject’s characteristic aura prior to the seizure. Bradycardia began 3 s after the stimulation; due to this delay the authors note that other brain regions could be recruited to cause the bradycardia. Bradycardia was followed by asystole. Stimulation further back along the cingulate did not affect heart rate. Also provides a brief review of electrical stimulation studies of cortical influences on autonomic function in humans. Refers to study of Britton et al. and Pool and Ransohoff.

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