title: Syncope, seizure-induced bradycardia and asystole: two cases and review of clinical and pathophysiological features.
abstract: Episodes of transient loss of consciousness (TLOC) are commonly due to syncope or epileptic seizures. The distinction between both entities on clinical grounds and eyewitness accounts can be challenging and is often hampered by similar clinical features. We briefly summarize syncope-related symptoms and present the case of a female patient who suffered from TLOC episodes due to both reflex syncope and epileptic seizures. Seizure-induced syncope is a rare complication particularly of non-generalized temporal lobe seizures and may be suspected in people with epilepsy who report new semiological features with sudden onset of atonia, TLOC and seizure-related falls. We review epidemiological, clinical and electroencephalographic aspects of seizure-related asystole and syncope and discuss their clinical relevance. The implantation of a cardiac pacemaker appears to efficiently prevent seizure-related falls and consecutive injuries and is an important treatment option if full seizure-control cannot be achieved in these patients. We describe a second case of a patient with refractory temporal lobe epilepsy and seizure-related syncope which ceased after the implantation of a cardiac pacemaker.
authors.affiliation: Cardiology Department, Samara Regional Cardiology Dispensary, Samara, Russia; Samara State Medical University, Samara, Russia. Electronic address: duplyakov@yahoo.com.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Duplyakov
authors.affiliation: Cardiology Department, VAZ Medical Center, Togliatti, Russia.
authors.forename: Galina
authors.initials: G
authors.lastname: Golovina
authors.affiliation: Neurology Department, Children's Multifield Hospital No. 1, Togliatti, Russia.
authors.forename: Natalia
authors.initials: N
authors.lastname: Lyukshina
authors.affiliation: Samara State Medical University, Samara, Russia.
authors.forename: Elena
authors.initials: E
authors.lastname: Surkova
authors.affiliation: Department of Epileptology, University Hospital Bonn, Germany.
authors.forename: Christian E
authors.initials: CE
authors.lastname: Elger
authors.affiliation: Department of Epileptology, University Hospital Bonn, Germany. Electronic address: rainer.surges@ukb.uni-bonn.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Surges
mesh_terms: D001919:Bradycardia / Q000175:diagnosis / Q000209:etiology*; D004562:Electrocardiography; D004569:Electroencephalography; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D012640:Seizures / Q000150:complications*; D013575:Syncope / Q000150:complications*
keywords: Ictal asystole; Reflex syncope; SUDEP; Sudden unexpected death in epilepsy; Temporal lobe epilepsy