title: The importance of cardiac monitoring in the epilepsy monitoring unit: a case presentation of ictal asystole.
abstract: Ictal asystole may be a potent marker for epilepsy patients at high risk for sudden unexpected death in epilepsy (SUDEP). The use of inpatient long-term video-electroencephalographic (VEEG) monitoring coupled with simultaneous continuous cardiac telemetry is an important tool to detect ictal asystole as well as other significant ictal cardiac arrhythmias. In this paper a case of ictal asystole detected during VEEG is presented. Routine 12-lead EKG was normal upon admission. After antiepileptic medication was tapered, the patient had a typical complex partial seizure with oral automatisms at onset followed by secondary generalization. Ictal onset was noted in left temporal lobe with subsequent spread to the right temporal region. A 20 second period of asystole began just prior to the secondary generalization. During this admission the patient underwent a potentially life-saving pacemaker implantation. The use of cardiac telemetry and baseline EKG are suggested for patients admitted into epilepsy monitoring units as part of the standard epilepsy monitoring protocol.
authors.affiliation: Banner Good Samaritan Medical Center, Epilepsy Monitoring Unit, Phoenix, Arizona, USA. Susan.Agostini@bannerhealth.com
authors.forename: Susan D
authors.initials: SD
authors.lastname: Agostini
authors.forename: Ejerzain
authors.initials: E
authors.lastname: Aniles
authors.forename: Joseph
authors.initials: J
authors.lastname: Sirven
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Drazkowski
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged