[Ictal syncopes. Cardiac sympathetic innervation disorder as the etiology?].
We report 3 cases of an ictal sinus arrest. All patients suffered from temporal lobe epilepsy (TLE). Seizures were monitored with simultaneous video-eeg during preoperative epilepsy diagnosis. One patient with cortical dysplasia, who frequently suffered from long lasting syncopes, had a nearly completely missing cardiac sympathetic innervation in MIBG-SPECT (=Meta-Iodide-Benzyle-Guanidine-single-photon-emission tomography). Cardiac investigation including long-term ECG and echocardiography had shown normal findings. After epilepsy surgery the syncopal events in all patients disappeared. A dominant parasympathetic ictal stimulus following excitation of the reticular formation might cause the ictal bradycardia and sinus arrest. A missing sympathetic innervation, possibly occurring as fehlbildung together with cortical dysplasia, which makes autoregulation impossible, might then be the explanation for sudden cardiac ictal death.
Neurologische Klinik mit Poliklinik, Universität Erlangen-Nürnberg.
S
S
Manitius-Robeck
P
P
Schüler
H
H
Feistel
G
G
Platsch
H
H
Stefan
D000328:Adult; D002540:Cerebral Cortex / Q000002:abnormalities / Q000503:physiopathology; D003952:Diagnostic Imaging; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006321:Heart / Q000294:innervation*; D006801:Humans; D008297:Male; D012154:Reticular Formation / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology
Iktuale Synkopen. Kardiale sympathische Innervationsstörung als Ursache?