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GAD65 antibody-associated autoimmune epilepsy with unique independent bitemporal-onset ictal asystole Volume 20, numéro 3, June 2018

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(1) When should autoimmune epilepsy be suspected?

(2) What is the lateralization value of ictal asystole (right or left hemisphere)?

(3) Should patients with ictal asystole receive pacemaker placement?

 

 

 

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Answers

(1) Autoimmune epilepsy should be suspected in cases of epilepsy with frequent seizures from the outset, neuropsychiatric manifestations, seizure variability or multifocality, family or personal history of autoimmunity, or neoplasm. Seizures occur as an early and prominent feature in autoimmune epilepsy syndromes, and these are characteristically refractory to conventional antiepileptic drug (AED) therapy.

(2) The neuroanatomical localization of ictal asystole (IA) most likely relates to insular and temporal lobe involvement. IA is typically seen in temporal, left-sided-onset, long-standing, drug-resistant epilepsy. However, these elements, particularly lateralization, have been reported inconsistently. Independent, bilateral temporal onset of seizures with IA in our patient also argues against a specific lateralization.

(3) The usefulness of pacemakers in ictal asystole has long been debated. In the setting of an acute and potentially reversible CNS insult, such as encephalitis and gliomas, treatment of the encephalitis or tumour resection, along with AEDs, may be sufficient to reduce the risk of further episodes of ictal asystole. In cases in which seizures cannot be fully controlled by AEDs or alternative treatments (e.g. epilepsy surgery), implantation of a cardiac pacemaker seems advisable to prevent syncope-related injuries.

 

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