Epileptic seizures associated with syncope: ictal bradycardia and ictal asystole

Carlos Paul Monté (Corresponding author), Carlos Jules Monté, Paul Boon, Johan Arends

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Introduction: Heart rate decrease during epileptic seizures is rare and should be considered in patients with unusual or refractory episodes of syncope or in patients with a history suggestive of both epilepsy and syncope. We systematically reviewed the literature to better understand the clinical signs and risk factors of ictal heart rate decreases. Material and methods: We performed a literature-search on “ictal bradycardia” and “ictal asystole” in Pubmed and added papers from the references and personal archives. Articles relating to animal studies, seizures without ictal decrease of heart rate, cases without simultaneous electroencephalography (EEG) and electrocardiography (ECG), convulsive syncopes, or cases with bradycardia before seizure onset and articles written in other languages than English, Dutch, German, French, or Spanish were excluded. Full texts of the remaining articles were screened for cases of ictal bradycardia or ictal asystole. Cases were selected on the basis of a self-designed quality score. The relationship of RR wave interval of at least 5 s, signs of syncope, and EEG signs of ischemia were analyzed with chi-square test and identifying 95% confidence intervals. Results: Ictal bradycardia and ictal asystole predominantly occurred during focal seizures with loss of awareness (proportion in the combined group of bradycardia and asystole (p1 + 2) = 0.85) in people with mainly left lateralized (p1 + 2 = 0.64; p = 0.001) temporal lobe seizures (p1 + 2 = 0.91). Seizures with ictal asystole typically started with a heart rate decrease. During ictal asystole in the majority of cases, not only the clinical signs of syncope occurred (change of proportion (Δp) = 0.67; 95% CI: 0.48–0.86; p < 0.0001), i.e., interrupting the seizure semiology, but also the characteristic EEG signs of ischemia (Δp = 0.50; 95% CI: 0.26–0.74; p < 0.001). We found a statistically significant relation between signs of syncope and EEG signs of ischemia (Δp = − 0.37; 95% CI: (− 0.64)–(− 0.10); p < 0.01) but not between duration of asystole (5 s) and either signs of syncope (Δp = − 0.36; 95% CI: (− 0.77)–0.05; p = 0.03) or EEG signs of ischemia (Δp = − 0.37; 95% CI: (− 1.07)–0.33; p = 0.16). Conclusion: In the ictal bradycardia syndrome, signs of syncope disrupt the semiology of ongoing seizures and are associated with EEG signs of brain ischemia and the duration of the cardiac arrhythmia.

LanguageEnglish
Pages168-171
Number of pages4
JournalEpilepsy and Behavior
Volume90
DOIs
StatePublished - 19 Dec 2019

Fingerprint

Syncope
Bradycardia
Heart Arrest
Epilepsy
Stroke
Seizures
Electroencephalography
Ischemia
Heart Rate
Temporal Lobe
Chi-Square Distribution
Brain Ischemia
PubMed
Cardiac Arrhythmias
Electrocardiography
Language
History
Confidence Intervals

Keywords

  • EEG
  • Ictal asystole
  • Ictal bradycardia
  • Syncope

Cite this

@article{240b7cacd30d487cabce429442b26df3,
title = "Epileptic seizures associated with syncope: ictal bradycardia and ictal asystole",
abstract = "Introduction: Heart rate decrease during epileptic seizures is rare and should be considered in patients with unusual or refractory episodes of syncope or in patients with a history suggestive of both epilepsy and syncope. We systematically reviewed the literature to better understand the clinical signs and risk factors of ictal heart rate decreases. Material and methods: We performed a literature-search on “ictal bradycardia” and “ictal asystole” in Pubmed and added papers from the references and personal archives. Articles relating to animal studies, seizures without ictal decrease of heart rate, cases without simultaneous electroencephalography (EEG) and electrocardiography (ECG), convulsive syncopes, or cases with bradycardia before seizure onset and articles written in other languages than English, Dutch, German, French, or Spanish were excluded. Full texts of the remaining articles were screened for cases of ictal bradycardia or ictal asystole. Cases were selected on the basis of a self-designed quality score. The relationship of RR wave interval of at least 5 s, signs of syncope, and EEG signs of ischemia were analyzed with chi-square test and identifying 95{\%} confidence intervals. Results: Ictal bradycardia and ictal asystole predominantly occurred during focal seizures with loss of awareness (proportion in the combined group of bradycardia and asystole (p1 + 2) = 0.85) in people with mainly left lateralized (p1 + 2 = 0.64; p = 0.001) temporal lobe seizures (p1 + 2 = 0.91). Seizures with ictal asystole typically started with a heart rate decrease. During ictal asystole in the majority of cases, not only the clinical signs of syncope occurred (change of proportion (Δp) = 0.67; 95{\%} CI: 0.48–0.86; p < 0.0001), i.e., interrupting the seizure semiology, but also the characteristic EEG signs of ischemia (Δp = 0.50; 95{\%} CI: 0.26–0.74; p < 0.001). We found a statistically significant relation between signs of syncope and EEG signs of ischemia (Δp = − 0.37; 95{\%} CI: (− 0.64)–(− 0.10); p < 0.01) but not between duration of asystole (5 s) and either signs of syncope (Δp = − 0.36; 95{\%} CI: (− 0.77)–0.05; p = 0.03) or EEG signs of ischemia (Δp = − 0.37; 95{\%} CI: (− 1.07)–0.33; p = 0.16). Conclusion: In the ictal bradycardia syndrome, signs of syncope disrupt the semiology of ongoing seizures and are associated with EEG signs of brain ischemia and the duration of the cardiac arrhythmia.",
keywords = "EEG, Ictal asystole, Ictal bradycardia, Syncope",
author = "Mont{\'e}, {Carlos Paul} and Mont{\'e}, {Carlos Jules} and Paul Boon and Johan Arends",
year = "2019",
month = "12",
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doi = "10.1016/j.yebeh.2018.10.027",
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volume = "90",
pages = "168--171",
journal = "Epilepsy and Behavior",
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Epileptic seizures associated with syncope : ictal bradycardia and ictal asystole. / Monté, Carlos Paul (Corresponding author); Monté, Carlos Jules; Boon, Paul; Arends, Johan.

In: Epilepsy and Behavior, Vol. 90, 19.12.2019, p. 168-171.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Epileptic seizures associated with syncope

T2 - Epilepsy and Behavior

AU - Monté,Carlos Paul

AU - Monté,Carlos Jules

AU - Boon,Paul

AU - Arends,Johan

PY - 2019/12/19

Y1 - 2019/12/19

N2 - Introduction: Heart rate decrease during epileptic seizures is rare and should be considered in patients with unusual or refractory episodes of syncope or in patients with a history suggestive of both epilepsy and syncope. We systematically reviewed the literature to better understand the clinical signs and risk factors of ictal heart rate decreases. Material and methods: We performed a literature-search on “ictal bradycardia” and “ictal asystole” in Pubmed and added papers from the references and personal archives. Articles relating to animal studies, seizures without ictal decrease of heart rate, cases without simultaneous electroencephalography (EEG) and electrocardiography (ECG), convulsive syncopes, or cases with bradycardia before seizure onset and articles written in other languages than English, Dutch, German, French, or Spanish were excluded. Full texts of the remaining articles were screened for cases of ictal bradycardia or ictal asystole. Cases were selected on the basis of a self-designed quality score. The relationship of RR wave interval of at least 5 s, signs of syncope, and EEG signs of ischemia were analyzed with chi-square test and identifying 95% confidence intervals. Results: Ictal bradycardia and ictal asystole predominantly occurred during focal seizures with loss of awareness (proportion in the combined group of bradycardia and asystole (p1 + 2) = 0.85) in people with mainly left lateralized (p1 + 2 = 0.64; p = 0.001) temporal lobe seizures (p1 + 2 = 0.91). Seizures with ictal asystole typically started with a heart rate decrease. During ictal asystole in the majority of cases, not only the clinical signs of syncope occurred (change of proportion (Δp) = 0.67; 95% CI: 0.48–0.86; p < 0.0001), i.e., interrupting the seizure semiology, but also the characteristic EEG signs of ischemia (Δp = 0.50; 95% CI: 0.26–0.74; p < 0.001). We found a statistically significant relation between signs of syncope and EEG signs of ischemia (Δp = − 0.37; 95% CI: (− 0.64)–(− 0.10); p < 0.01) but not between duration of asystole (5 s) and either signs of syncope (Δp = − 0.36; 95% CI: (− 0.77)–0.05; p = 0.03) or EEG signs of ischemia (Δp = − 0.37; 95% CI: (− 1.07)–0.33; p = 0.16). Conclusion: In the ictal bradycardia syndrome, signs of syncope disrupt the semiology of ongoing seizures and are associated with EEG signs of brain ischemia and the duration of the cardiac arrhythmia.

AB - Introduction: Heart rate decrease during epileptic seizures is rare and should be considered in patients with unusual or refractory episodes of syncope or in patients with a history suggestive of both epilepsy and syncope. We systematically reviewed the literature to better understand the clinical signs and risk factors of ictal heart rate decreases. Material and methods: We performed a literature-search on “ictal bradycardia” and “ictal asystole” in Pubmed and added papers from the references and personal archives. Articles relating to animal studies, seizures without ictal decrease of heart rate, cases without simultaneous electroencephalography (EEG) and electrocardiography (ECG), convulsive syncopes, or cases with bradycardia before seizure onset and articles written in other languages than English, Dutch, German, French, or Spanish were excluded. Full texts of the remaining articles were screened for cases of ictal bradycardia or ictal asystole. Cases were selected on the basis of a self-designed quality score. The relationship of RR wave interval of at least 5 s, signs of syncope, and EEG signs of ischemia were analyzed with chi-square test and identifying 95% confidence intervals. Results: Ictal bradycardia and ictal asystole predominantly occurred during focal seizures with loss of awareness (proportion in the combined group of bradycardia and asystole (p1 + 2) = 0.85) in people with mainly left lateralized (p1 + 2 = 0.64; p = 0.001) temporal lobe seizures (p1 + 2 = 0.91). Seizures with ictal asystole typically started with a heart rate decrease. During ictal asystole in the majority of cases, not only the clinical signs of syncope occurred (change of proportion (Δp) = 0.67; 95% CI: 0.48–0.86; p < 0.0001), i.e., interrupting the seizure semiology, but also the characteristic EEG signs of ischemia (Δp = 0.50; 95% CI: 0.26–0.74; p < 0.001). We found a statistically significant relation between signs of syncope and EEG signs of ischemia (Δp = − 0.37; 95% CI: (− 0.64)–(− 0.10); p < 0.01) but not between duration of asystole (5 s) and either signs of syncope (Δp = − 0.36; 95% CI: (− 0.77)–0.05; p = 0.03) or EEG signs of ischemia (Δp = − 0.37; 95% CI: (− 1.07)–0.33; p = 0.16). Conclusion: In the ictal bradycardia syndrome, signs of syncope disrupt the semiology of ongoing seizures and are associated with EEG signs of brain ischemia and the duration of the cardiac arrhythmia.

KW - EEG

KW - Ictal asystole

KW - Ictal bradycardia

KW - Syncope

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U2 - 10.1016/j.yebeh.2018.10.027

DO - 10.1016/j.yebeh.2018.10.027

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VL - 90

SP - 168

EP - 171

JO - Epilepsy and Behavior

JF - Epilepsy and Behavior

SN - 1525-5050

ER -