title: Bradycardia and asystole during generalised interictal EEG discharges.
abstract: Few studies have investigated the effects of interictal epileptic discharges on the cardiac autonomic system. This study reports the case of a 37-year-old man with refractory generalised epilepsy, who recently reported an increase in frequency of nocturnal tonic-clonic seizures, not responding to treatment. During the nocturnal video study, in non-rapid eye movements sleep, we recorded 106 generalised sharp- and polyspike-waves lasting for 3 to 7 seconds, associated with bradycardia and asystole, without behavioural changes and without increase in deltoid muscle activity. The asystole had a duration of between 3 and 8 seconds. In one case, a 7 second asystole was associated with a tonic-clonic generalised seizure. A 24-hour electrocardiographic study revealed a bradycardia and a Wenckebach atrioventricular block. Heart rate analysis at the time of the interictal epileptic discharges revealed an abrupt increase in the RR interval, occurring simultaneously with the onset of interictal epileptic discharges and followed by a return to values below baseline value. A cardiac pacemaker was installed with a reduction of asystole length during the interictal epileptic discharges. Our findings indicate, for the first time, the role of interictal generalised discharges in EEG-related asystole and bradycardia. These data support the hypothesis that some patients with epilepsy may be predisposed to disturbances of the autonomic cardiac system.
authors.affiliation: Fondation Institution of Lavigny, Lavigny, Switzerland, Service de Physiologie Clinique et de l'Exercice (Pôle Hospitalier NOL), CHU Nord, SNA-EPIS EA 4607, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France.
authors.forename: Emilia
authors.initials: E
authors.lastname: Sforza
authors.affiliation: Service de Physiologie Clinique et de l'Exercice (Pôle Hospitalier NOL), CHU Nord, SNA-EPIS EA 4607, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pichot
authors.affiliation: Fondation Institution of Lavigny, Lavigny, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Gschwind
authors.affiliation: Service de Physiologie Clinique et de l'Exercice (Pôle Hospitalier NOL), CHU Nord, SNA-EPIS EA 4607, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Roche
authors.affiliation: Fondation Institution of Lavigny, Lavigny, Switzerland.
authors.forename: Malin
authors.initials: M
authors.lastname: Maeder-Ingvar
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D001919:Bradycardia / Q000209:etiology* / Q000503:physiopathology; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D006323:Heart Arrest / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male
keywords: asystole; autonomic nervous system; bradycardia; epilepsy; interictal generalized discharges