Authors :
Presenting Author: Toshihiro Fukusako, MD, PhD – Yamaguchi Grand Medical Center
Masami Fujii, MD, PhD – Yamaguchi Grand Medical Center
Yuki Mizumoto, MD, PhD – Yamaguchi Prefectural Grand Medical Center
Toshikazu Nagatsuna, MD – Yamaguchi Grand Medical Center
Rationale:
Ictal asystole is a rare phenotype of epileptic seizures that presents with asystole during ictal seizures and is suspected to be related to temporal lobe epilepsy (TLE). We report a rare case of epilepsy in which ictal asystole was detected by an implantable cardiac monitor (ICM) and seizures disappeared with anti-seizure medication.
Methods:
A 48-year-old male experienced a convulsive symptom for about 2 minutes without warning while lying on a bed and using a smartphone. Eight days later, he had a similar symptom in the bathroom and was transported by ambulance to a nearby hospital. An electrocardiogram, echocardiogram, coronary CT, head MRI, and EEG showed no abnormalities. Syncope was suspected and an ICM was implanted. About 2 months later, the patient had a similar symptom and the ICM showed tachycardia followed by asystole for 9 seconds. The clinical symptoms could not be explained by syncope, and he was referred to our Epilepsy Center for suspected epilepsy.
Results:
After visiting our hospital, he experienced the same symptom after feeling pale. Epilepsy was suspected and simultaneous video-EEG monitoring was performed for 5 days, but no seizures occurred. Background EEG activity was within the normal range and there were no obvious epileptic discharges. However, the repeated symptoms were thought to be due to bilateral tonic-clonic seizure (BTCS), and thus, oral administration of levetiracetam (LEV) was initiated. A leadless pacemaker was also implanted for asystole. After more than one year of LEV administration, there has been no asystole and BTCS has been suppressed.
Conclusions:
In convulsive seizures accompanied by loss of consciousness and asystole, it is important to differentiate between convulsive syncope and ictal asystole. The ICM was useful in detecting asystole associated with epileptic seizures. This case cannot be said to be typical because obvious focal impaired awareness seizures and/or epileptic discharges on EEG were not identified; however, we believe it to be focal epilepsy based on the age of onset and seizure symptoms.
Funding: No