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Ictal asystole with intercurrent cardiopathy: a complex combination leading to delayed diagnosis Volume 21, issue 6, December 2019

Excerpt of video-EEG and ECG recording of the first seizure, out of 11 recorded during the patient’s stay. The first ECG change occurred 10 seconds after the seizure onset, with gradual heart rate deceleration from 70 to 40 bpm over eight seconds. This heartbeat slowing was associated with theta-delta rhythmic activity over right temporalfrontal regions. The EEG then also displayed right-lateralized periodic sharp waves while heart rate was still decreasing to 28 bpm. Approximately 36 seconds after seizure onset, an asystole occurred lasting 19 seconds. During the first ten seconds of asystole, the EEG transitioned from the mixed pattern including lateralized rhythmic and periodic activity to a diffuse slowing. Thereafter, an EEG flattening was noted, and the patient became completely motionless. Heart rate returned first, and ten seconds later, brain activity also resumed. Subsequently, the patient manifested a generalized myoclonic jerk while the EEG showed diffuse 2-3-Hz delta activity. The patient was interviewed later and recalled having experienced a “wonderful feeling of leaving his body” during the seizure.

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