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Comparison of clinical and electrophysiological characteristics between ictal and cardiac asystole encountered during video-EEG monitoring Volume 21, numéro 4, August 2019

TEST YOURSELF

(1) In patients presenting with recurrent transient loss of consciousness, what clinical cues aid in distinguishing between cardiovascular syncope and ictal syncope?

(2) Is there an indisputable and consistent association between ictal asystole and chronic drug-resistant left temporal lobe epilepsy?

(3) Does detection of ictal asystole warrant urgent cardiac pacemaker implantation?

 

 

 

 

 

 

 

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Answers

(1) While heralding symptoms, such as light headedness, dizziness and blurring of vision, atonic falls, and few, irregular jerks after the fall would strongly favour a cardiovascular syncope, slow evolution of the symptoms with behavioural arrest and automatisms progressing on to fall and convulsive jerks lasting for several seconds or a few minutes support the diagnosis of ictal syncope.

 

(2) Even though ictal asystole is more often associated with chronic drug-resistant epilepsy, it may occur in the setting of drug-responsive new-onset epilepsy. While the seizure onset zone is more often lateralized to the left and localized to the temporal lobe, prolonged ictal asystole is more frequently encountered with secondary generalized and extratemporal-onset seizures. Furthermore, intracranial EEG recordings have shown that asystole often appears when the ictal activity has become widespread and bilateral, thereby casting reservations on the reliability of scalp-recorded ictal EEG lateralization and localization.

 

(3) Compared to postictal asystole, IA is often a self-limiting condition. Although it can result in syncope-related falls and injuries, control of seizures by AEDs or surgery prevent these morbidities in the majority. Only in a minority of non-surgical drug-resistant IA patients with prolonged asystole does cardiac pacemaker implantation become necessary.

 

 

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