title: Syncope, seizure or both?
abstract: Ictal asystole (IA) is a rare phenomenon in patients with seizures with an incidence of 0.27-0.4% and has been proposed as a possible mechanism of sudden unexpected death in epilepsy patients (SUDEP). We present a case of a 53-year-old woman who initially presented with episodes of expressive aphasia and was treated with antiepileptic drugs (AEDs). While on therapy she experienced episodes of syncope. During her hospitalization for tapering of AEDs and 24-hour EEG monitoring, the patient developed a seizure followed by sinus bradycardia and an 18-second sinus pause, resulting in loss of consciousness and slowing of cerebral activity. Ten seconds after the return of cardiac activity, the EEG showed return of cerebral activity. A dual chamber pacemaker was implanted.
authors.affiliation: a Department of Medicine , Division of Cardiovascular Medicine, Stony Brook University , Stony Brook , NY , USA.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Koutrolou-Sotiropoulou
authors.affiliation: a Department of Medicine , Division of Cardiovascular Medicine, Stony Brook University , Stony Brook , NY , USA.
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Singh
authors.affiliation: b Department of Neurology , Stony Brook University , Stony Brook , NY , USA.
authors.forename: Mason
authors.initials: M
authors.lastname: Leeman-Markowski
authors.affiliation: a Department of Medicine , Division of Cardiovascular Medicine, Stony Brook University , Stony Brook , NY , USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Rashba
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage*; D015716:Electrocardiography, Ambulatory / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: Ictal asystole; seizures; sudden unexpected death in epilepsy