title: Ictal Asystole in Focal Epilepsy: To Pace or Not to Pace?
abstract: Ictal bradyarrhythmias are rare episodes occurring in patients with or without a past cardiac history. These episodes go unnoticed unless the patient is monitored on simultaneous video-electroencephalogram and 1-lead electrocardiogram. Recognizing ictal bradyarrhythmias is important, since episodes may predispose patients to sudden, unexplained death in epilepsy. We present 2 cases of ictal asystole in patients with right temporal lobe epilepsy. The first patient had seizures refractory to medical therapy and received a pacemaker. The seizures in the second patient responded well to antiepileptic medication, and a pacemaker was deferred. These cases highlight the differing cardiovascular treatment options for ictal asystole.
authors.affiliation: Department of Neurology, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Newey
authors.affiliation: Department of Anesthesiology (Section on Critical Care Medicine), Wake Forest School of Medicine, Winston-Salem, NC, USA ; Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Aarti
authors.initials: A
authors.lastname: Sarwal
keywords: ictal asystole; pacemaker