[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.
Manitius-Robeck
S
S
Neurologische Klinik mit Poliklinik, Universität Erlangen-Nürnberg.
Schüler
P
P
Feistel
H
H
Platsch
G
G
Stefan
H
H
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?