title: Asystole in the epilepsy unit.
abstract: BACKGROUND
  Early identification of cardiac asystole as a reason for syncope is of uttermost significance, as insertion of a cardiac pacemaker can save the patient's life and prevent severe injury. The aim of this work was to emphasize the subtle and unusual presentations of asystole in patients evaluated in epilepsy units.
  
  
  METHODS
  We reviewed the clinical presentation, ECG and EEG data of a series of seven patients who were evaluated in four epilepsy units and were diagnosed with asystole.
  
  
  RESULTS
  Three patients had unusual clinical manifestations of cardiac asystole, resembling epileptic seizures. Three patients had asystole induced by epileptic seizures and in one patient the diagnosis was not clear. All patients except one were implanted with a pacemaker and improved clinically.
  
  
  CONCLUSIONS
  Seizure-induced asystole is a rare complication of epilepsy and asystole may clinically mimic epileptic seizures. A high level of suspicion and thorough prolonged cardiac and EEG monitoring are mandatory for reaching the right diagnosis. As the diagnosis is rare and difficult to reach, a flow chart to assist diagnosis is suggested.
authors.affiliation: Department of Neurology, the Agnes Ginges Center of Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. asaf.honig2@gmail.com.
authors.forename: Asaf
authors.initials: A
authors.lastname: Honig
authors.affiliation: Department of Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Shmuel.chen@mail.huji.ac.il.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Neurology, Rabin Medical Center, Petach Tikva, Israel. felixbenninger@gmail.com.
authors.forename: Felix
authors.initials: F
authors.lastname: Benninger
authors.affiliation: Department of Neurology, the Agnes Ginges Center of Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. drbaryossef@gmail.com.
authors.forename: Rima
authors.initials: R
authors.lastname: Bar-Yossef
authors.affiliation: Department of Neurology, the Agnes Ginges Center of Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. eichel@hadassah.org.il.
authors.forename: Roni
authors.initials: R
authors.lastname: Eichel
authors.affiliation: EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. svetlanakip@hotmail.com.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Kipervasser
authors.affiliation: Department of Neurology, Sheba Medical Center, Tel-Hashomer, Israel. Ilan.Blatt@sheba.health.gov.il.
authors.forename: Ilan
authors.initials: I
authors.lastname: Blatt
authors.affiliation: EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. neufeldm@tasmc.health.gov.il.
authors.forename: Miri Y
authors.initials: MY
authors.lastname: Neufeld
authors.affiliation: Department of Neurology, the Agnes Ginges Center of Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. dekstein@hadassah.org.il.
authors.forename: Dana
authors.initials: D
authors.lastname: Ekstein
mesh_terms: D000328:Adult; D004562:Electrocardiography; D004569:Electroencephalography; D006323:Heart Arrest / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D012640:Seizures / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D014474:Unconsciousness / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult