Ictal asystole in temporal lobe epilepsy before and after pacemaker implantation

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Strzelczyk A, Bauer S, Knake S, Oertel WH, Hamer HM, and Rosenow F (2008) Ictal asystole in temporal lobe epilepsy before and after pacemaker implantation. Epileptic Disord 10:1 39–44.

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Abstract: Events of ictal bradycardia or asystole may be of relevance in epilepsy patients presenting with ictal falls, and are a potential contributor to SUDEP. The literature on ictal bradycardia or asystole is anecdotal and consists of case reports and small case series. There are no guidelines for the care of patients with ictal arrhythmias. Insertion of cardiac pacemakers may prevent life-threatening cardiac arrest, syncope and trauma. We report the case of a 41-year-old man who presented with refractory partial seizures resulting in syncope leading to severe head trauma, as the only ictal semiology. During presurgical video-EEG monitoring, two episodes of ictal bradycardia followed by asystole and syncope were recorded. A cardiac pacemaker was implanted. At the nine-month follow-up, the patient reported no overt seizures, syncopes or traumatic falls. Our case demonstrates that implantation of a cardiac pacemaker while continuing AEDs may render a patient free from ictal symptoms and prevent ictal syncope and subsequent trauma. [Published with video sequences].

Keywords: cardiac asystole, bradycardia, SUDEP, temporal lobe epilepsy, pacemaker


  • Case report of patient who suffered asystole with seizures prior to implantation of pacemaker, which reduced such events. A similar case was reported by Zubair et al. (2009). Patients with a clear history of ictal asystole could benefit from such a procedure. Investigation of whether the procedure prevents SUDEP would be of interest, though it would be difficult to determine the appropriate control group, as patients with symptomatic ictal bradycardia or asystole would presumably all undergo pacemaker implantation.