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Cardiac arrest associated with epileptic seizures: A case report with simultaneous EEG and ECG.

Mehvari J, Fadaie F, Omidi S, Poorsina M, Najafi Ziarani M, Gharekhani M, Beladimoghadam N, Rahimian E, Moein H, Barakatain M, Basiratnia M, Hashemi Fesharaki SS - Epilepsy Behav Case Rep (2014)

Bottom Line: During long-term video-EEG monitoring, he had one generalized tonic-clonic seizure accompanied by bradycardia and cardiac asystole.In cases of epileptic cardiac dysrhythmia, prolonged simultaneous EEG/ECG monitoring may be required.Cardiological investigation should be included in epilepsy management.

View Article: PubMed Central - PubMed

Affiliation: Shefa Neuroscience Research Center, Khatamolanbia Hospital, Tehran, Iran ; Isfahan Neurosciences Research Center, Isfahan, Iran.

ABSTRACT
Ictal asystole is a rare, probably underestimated manifestation of epileptic seizures whose pathophysiology is still debated. This report describes two patients who had cardiac asystole at the end of their seizure. The first patient was a 13-year-old boy with complex partial seizures.. His MRI showed symmetrical signal abnormality in the bilateral parietooccipital lobe accompanied by mild gliosis and volume loss. During a 3-day long-term video-EEG monitoring, he had cardiac arrest at the end of one of his seizures that was secondarily generalized. The second one was a 42-year-old veteran with penetrating head trauma in the left frontal lobe due to shell injury. During long-term video-EEG monitoring, he had one generalized tonic-clonic seizure accompanied by bradycardia and cardiac asystole. Asystoles could have a role in the incidence of sudden unexpected death in epilepsy (SUDEP), meaning that the presence of ictal bradycardia is a risk factor for SUDEP. In cases of epileptic cardiac dysrhythmia, prolonged simultaneous EEG/ECG monitoring may be required. Cardiological investigation should be included in epilepsy management.

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Mentions: A thirteen-year-old right-handed male with seizure disorder was admitted for a presurgical assessment. There was a history of neonatal hypoglycemia during an apparently normal vaginal delivery. No history of birth injury was recorded. He was diagnosed with epilepsy at the age of 5–6 months. The first seizure was associated with secondary generalization. He was started on antiepileptic drugs, but the second seizure appeared six months later. He was symptom-free for 1 year. Habitual seizures began at the age of 10. The seizures typically consisted of blurred vision and upward gaze followed by a loss of consciousness. Many times, there were secondary generalized tonic–clonic seizures. The results of physical and neurological exams were unremarkable. His MRI showed near symmetrical signal abnormality at parietooccipital regions bilaterally (parasagittal aspect) accompanied by mild gliosis and volume loss (Fig. 4). During monitoring, 5 clinical seizures with electrographic changes were recorded. In one episode, there was bilateral rhythmic activity maximum to the left associated with right-side clonic jerk and head and eye deviation to the right that secondarily generalized and was followed by 16 s of asystole at the end of the seizure (Fig. 1, Fig. 2, Fig. 3). Interictal abnormality consisted of bilateral spike-and-wave and bilateral slow activity maximum in the right posterior head region. At the end of monitoring, an anticonvulsant drug regimen of valproic acid and levetiracetam was started, and cardiology consultation was suggested.


Cardiac arrest associated with epileptic seizures: A case report with simultaneous EEG and ECG.

Mehvari J, Fadaie F, Omidi S, Poorsina M, Najafi Ziarani M, Gharekhani M, Beladimoghadam N, Rahimian E, Moein H, Barakatain M, Basiratnia M, Hashemi Fesharaki SS - Epilepsy Behav Case Rep (2014)

© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4307967&req=5

Mentions: A thirteen-year-old right-handed male with seizure disorder was admitted for a presurgical assessment. There was a history of neonatal hypoglycemia during an apparently normal vaginal delivery. No history of birth injury was recorded. He was diagnosed with epilepsy at the age of 5–6 months. The first seizure was associated with secondary generalization. He was started on antiepileptic drugs, but the second seizure appeared six months later. He was symptom-free for 1 year. Habitual seizures began at the age of 10. The seizures typically consisted of blurred vision and upward gaze followed by a loss of consciousness. Many times, there were secondary generalized tonic–clonic seizures. The results of physical and neurological exams were unremarkable. His MRI showed near symmetrical signal abnormality at parietooccipital regions bilaterally (parasagittal aspect) accompanied by mild gliosis and volume loss (Fig. 4). During monitoring, 5 clinical seizures with electrographic changes were recorded. In one episode, there was bilateral rhythmic activity maximum to the left associated with right-side clonic jerk and head and eye deviation to the right that secondarily generalized and was followed by 16 s of asystole at the end of the seizure (Fig. 1, Fig. 2, Fig. 3). Interictal abnormality consisted of bilateral spike-and-wave and bilateral slow activity maximum in the right posterior head region. At the end of monitoring, an anticonvulsant drug regimen of valproic acid and levetiracetam was started, and cardiology consultation was suggested.

Bottom Line: During long-term video-EEG monitoring, he had one generalized tonic-clonic seizure accompanied by bradycardia and cardiac asystole.In cases of epileptic cardiac dysrhythmia, prolonged simultaneous EEG/ECG monitoring may be required.Cardiological investigation should be included in epilepsy management.

View Article: PubMed Central - PubMed

Affiliation: Shefa Neuroscience Research Center, Khatamolanbia Hospital, Tehran, Iran ; Isfahan Neurosciences Research Center, Isfahan, Iran.

ABSTRACT
Ictal asystole is a rare, probably underestimated manifestation of epileptic seizures whose pathophysiology is still debated. This report describes two patients who had cardiac asystole at the end of their seizure. The first patient was a 13-year-old boy with complex partial seizures.. His MRI showed symmetrical signal abnormality in the bilateral parietooccipital lobe accompanied by mild gliosis and volume loss. During a 3-day long-term video-EEG monitoring, he had cardiac arrest at the end of one of his seizures that was secondarily generalized. The second one was a 42-year-old veteran with penetrating head trauma in the left frontal lobe due to shell injury. During long-term video-EEG monitoring, he had one generalized tonic-clonic seizure accompanied by bradycardia and cardiac asystole. Asystoles could have a role in the incidence of sudden unexpected death in epilepsy (SUDEP), meaning that the presence of ictal bradycardia is a risk factor for SUDEP. In cases of epileptic cardiac dysrhythmia, prolonged simultaneous EEG/ECG monitoring may be required. Cardiological investigation should be included in epilepsy management.

No MeSH data available.


Related in: MedlinePlus