Idiopathic cardiac asystole presenting as an intractable adult onset partial seizure disorder

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Venkataraman V, Wheless JW, Willmore LJ, and Motookal H (2001) Idiopathic cardiac asystole presenting as an intractable adult onset partial seizure disorder. Seizure 10:5 359–64.

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Abstract: Asystole can occur during partial seizures. Conversely, asystole may produce clinical features associated semiologically with partial or secondarily generalized tonic--clonic seizures. Management is so profoundly different that accurate diagnosis is critical. We performed simultaneous scalp video electroencephalographic (EEG) and electrocardiographic (ECG) recordings in three patients who presented with an intractable seizure disorder. Habitual events were captured and reviewed. These revealed similar clinical features and temporal association with the ECG and EEG findings. Idiopathic asystole was detected as the cause in all three. All underwent emergency cardiac pacemaker implantation with resultant cessation of their paroxysmal episodes. If this diagnostic study had been delayed or not performed, all of our patients could have presented as sudden unexpected death in epilepsy (SUDEP). Early video-EEG and ECG monitoring is essential in adults with intractable seizure disorders.

Keywords: asystole; SUDEP; syncope; intractable seizures; epilepsy.


  • Simultaneous EEG and EKG in 3 patients showed idopathic asystole that led to paroxysms, resulting in misdiagnosis of seizure disorder. Pacemaker implantation was curative in all three patients. Similar misdiagnosis was reported by Witzenbichler et al.


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