Abstract Details

Title Prolonged Asystole: Neurogenic vs. Cardiac Origin? (Ictal Cardiac Asystole Captured during Invasive Video EEG Monitoring with Successful Surgical Outcome)

Topic Epilepsy

Presentation(s) P03 - (-)

Poster/Presentation
Number 140

Objective

Background BACKGROUND: Bradycardia and cardiac asystole as ictal phenomena are under recognized but previously described features in patients with medically refractory partial epilepsy. However, previous documentation of ictal bradyarrhythmia and ictal asystole emanating concurrently from the right frontal and temporal lobe seizures are infrequent. There are no reports of patients with ictal asystole that have successfully undergone invasive EEG monitoring followed by resective epilepsy surgery with resolution of seizures and bradyarrhythmia.

Design/Methods DESIGN/METHODS: We present a patient with medically refractory partial epilepsy who was diagnosed with seizure related ictal bradyarrhythmia and asystole during invasive depth electrode EEG monitoring, and subsequently underwent successful resective epilepsy surgery. A 36 year old male with medically refractory partial seizures presented with a history of sudden falls and generalized seizures. Synchronized video EEG monitoring with EKG recordings on an implanted cardiac loop recorder suggested that the seizures were emanating simultaneously from the right orbitofrontal and right temporal lobes and were associated with ictal bradycardia and an episode of prolonged ictal asystole for 25 seconds.

Results RESULTS: The patient underwent right fronto-orbital lobe and the right hippocampal temporal resection. The patient has not had seizure spells during the following 3 year period of observation after the resective epilepsy surgery.

Conclusions CONCLUSIONS: In conclusion, the incidence of life-threatening cardiac symptoms such as ictal bradyarrhythmia and ictal asystole are perhaps more frequent than documented and its awareness should be increased. Also, the presence of the ictal bradyarrhythmia and asystole are not a contraindications the resective epilepsy surgery.

Authors/Disclosures
Anishee S. Undavia, MD (Penn Medicine (Penn Specialty Practices)) PRESENTER	Dr. Undavia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Undavia has received personal compensation in the range of $0-$499 for serving as a Consultant for Inlightened.
Jordan S. Dubow, MD	Dr. Dubow has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Revalesio .
Dawn Eliashiv, MD, FAAN (UCLA)	Dr. Eliashiv has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace. Dr. Eliashiv has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Eliashiv has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Eliashiv has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for eisai. Dr. Eliashiv has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for SK Lifesciences. Dr. Eliashiv has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. Dr. Eliashiv has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic's. Dr. Eliashiv has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for neuropace. The institution of Dr. Eliashiv has received research support from NINDS. The institution of Dr. Eliashiv has received research support from Neuropace. Dr. Eliashiv has received publishing royalties from a publication relating to health care.
Jeffrey M. Chung, MD, FAAN (Cedars-Sinai Medical Center)	Dr. Chung has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Asvar Law. Dr. Chung has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Oak Crest Institute of Science.
John R. Jefferson, MD (Seton)	Dr. Jefferson has nothing to disclose.
Evgeny Tsimerinov, MD, PhD, FAAN (Neurology, Inc)	No disclosure on file

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