title: Ictal asystole: A systematic review.
abstract: To comprehensively analyze ictal asystole (IA) on a large number of subjects.
  
  
  
  We performed a systematic review of case report studies of patients diagnosed with IA (1983-2016). Each included case was characterized with respect to patient history, IA seizure characteristics, diagnostic workup, and therapy. In addition, comparative analyses were also carried out: two alignments were developed based on the delay between epilepsy onset and IA onset ("new-onset" if <1 year, "late-onset" if ≥1 year) and asystole duration (asystole was "very prolonged" if lasted >30 s).
  
  
  
  One hundred fifty-seven cases were included. All patients had focal epilepsy. In 7% of cases IA developed during a secondary generalized tonic-clonic seizure. Both the seizure-onset zone and the focal seizure activity at asystole beginning were usually temporal (p < 0.001 and p = 0.001, respectively) and were lateralized to the left hemisphere in 62% (p = 0.005 and p = 0.05, respectively). Asystole duration was 18 ± 14 s (mean±SD) (range 3-96 s); 73% of patients had late-onset, 27% had new-onset IA. Compared to late-onset IA, new-onset IA was associated with female gender (p = 0.023), preexisting heart condition (p = 0.014), focal seizure activity at asystole beginning (p = 0.012), normal neuroimaging (p = 0.013), normal interictal EEG (p < 0.001), auditory aura (p = 0.012), and drug-responsive epilepsy (p < 0.001). "Very prolonged" asystole was associated with secondary generalized tonic-clonic seizures (p = 0.003) and tended to occur in extratemporal lobe seizures (p = 0.074). No IA-related death was reported.
  
  
  
  Characteristics considered to be typical of IA (focal, left temporal seizures appearing on grounds of a long-lasting, intractable epilepsy) seem only partially legitimate. We suggest that in new-onset IA, female gender and a preexisting heart condition could serve as predispositions in an otherwise benign epilepsy. We speculate that in late-onset IA, male-predominant changes in neuronal networks in chronic, intractable epilepsy and an accompanying autonomic dysregulation serve as facilitating factors.
authors.affiliation: Department of Neurology, University of Pécs, Pécs, Hungary.
authors.forename: Dalma
authors.initials: D
authors.lastname: Tényi
authors.affiliation: Department of Neurology, University of Pécs, Pécs, Hungary.
authors.forename: Csilla
authors.initials: C
authors.lastname: Gyimesi
authors.affiliation: Heart Institute, University of Pécs, Pécs, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Kupó
authors.affiliation: Department of Neurology, University of Pécs, Pécs, Hungary.
authors.forename: Réka
authors.initials: R
authors.lastname: Horváth
authors.affiliation: Department of Neurology, University of Pécs, Pécs, Hungary.
authors.forename: Beáta
authors.initials: B
authors.lastname: Bóné
authors.affiliation: MR Research Center, Semmelweis University, Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Barsi
authors.affiliation: Department of Neurology, University of Pécs, Pécs, Hungary.|PTE-MTA Clinical Neuroscience MR Research Group, Budapest, Hungary.
authors.forename: Norbert
authors.initials: N
authors.lastname: Kovács
authors.affiliation: Heart Institute, University of Pécs, Pécs, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Simor
authors.affiliation: Epilepsy Center, Bethesda Children's Hospital, Budapest, Hungary.
authors.forename: Zsuzsa
authors.initials: Z
authors.lastname: Siegler
authors.affiliation: Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Környei
authors.affiliation: Epilepsy Center, Bethesda Children's Hospital, Budapest, Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Fogarasi
authors.affiliation: Department of Neurology, University of Pécs, Pécs, Hungary.|PTE-MTA Clinical Neuroscience MR Research Group, Budapest, Hungary.
authors.forename: József
authors.initials: J
authors.lastname: Janszky
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004569:Electroencephalography; D005260:Female; D007839:Functional Laterality; D006323:Heart Arrest / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology*; D055815:Young Adult
keywords: Arrhythmogenic seizures; Autonomic nervous system; Cardiac arrest; Focal epilepsy