Management and long-term outcome in patients presenting with ictal asystole or bradycardia.


PURPOSE:Ictal asystole (IA) and ictal bradycardia (IB) are rare autonomic symptoms during epileptic seizures and may be potentially life-threatening. Guidelines for the care of these patients are missing. The aim of this multicenter study was to evaluate the management and long-term outcome in patients with IA and IB. PATIENTS AND METHODS:All patients with IA and IB were included from four epilepsy centers (Bielefeld, Kork, Marburg, and Zürich) from 2002 until 2009. Using a standardized assessment form, clinical data, treatment decisions, and outcomes were extracted from patient charts and simultaneous electroencephalography/electrocardiography (EEG/ECG) recordings. KEY FINDINGS:Seizures with IA or IB were identified in 16 patients. In all patients an associated temporal seizure pattern was recorded and in 15 patients, sudden falls, fainting, or trauma was previously reported or recorded during the monitoring. In three patients (18.8%) diagnosis of focal epilepsy was newly established and anticonvulsive treatment was initiated. Two patients with refractory epilepsy underwent epilepsy surgery. In seven patients (43.8%) a cardiac pacemaker was implanted. In 14 of 16 treated patients, seizure freedom (n = 5) or absence of sudden falls, fainting, or trauma (n = 9) could be achieved. Two patients denied epilepsy surgery as well as a pacemaker and continue to have frequent falls and trauma. SIGNIFICANCE:Our study demonstrates that epilepsy surgery and antiepileptic drugs may lead to sustained freedom of seizures as well as ictal syncope. In drug-resistant patients not suitable for epilepsy surgery, implantation of a cardiac pacemaker may prevent sudden falls as well as trauma. Based on our results and previously reported cases we propose a treatment algorithm.






Strzelczyk A,Cenusa M,Bauer S,Hamer HM,Mothersill IW,Grunwald T,Hillenbrand B,Ebner A,Steinhoff BJ,Krämer G,Rosenow F




Has Abstract


2011-06-01 00:00:00












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    pub_type: 杂志文章


    authors: Williams RP,Banwell B,Berg RA,Dlugos DJ,Donnelly M,Ichord R,Kessler SK,Lavelle J,Massey SL,Hewlett J,Parker A,Topjian AA,Abend NS

    更新日期:2016-05-01 00:00:00

  • Variable epilepsy phenotypes associated with a familial intragenic deletion of the SCN1A gene.

    abstract::Deletions and duplications/amplifications of the α1-sodium channel subunit (SCN1A) gene occur in about 12% of patients with Dravet syndrome (DS) who are otherwise mutation-negative. Such genomic abnormalities cause loss of function, with severe phenotypes, reproductive disadvantage and, therefore, sporadic occurrence....


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    authors: Guerrini R,Cellini E,Mei D,Metitieri T,Petrelli C,Pucatti D,Marini C,Zamponi N

    更新日期:2010-12-01 00:00:00

  • Significance of the electrophysiological border between hypothalamic hamartomas and the hypothalamus for the target of ablation surgery identified by intraoperative semimicrorecording.

    abstract:OBJECTIVE:Ablation surgery has become the first line of treatment for hypothalamic hamartomas (HHs). For effective treatment, optimum targeting of ablation is mandatory. The present study aimed to evaluate the correspondence between the electrophysiological features of HHs and morphological targeting by semimicrorecord...


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    authors: Shirozu H,Masuda H,Kameyama S

    更新日期:2020-12-01 00:00:00

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    authors: Marini C,Harvey AS,Pelekanos JT,Berkovic SF

    更新日期:2003-09-01 00:00:00

  • No evidence of a role for cystatin B gene in juvenile myoclonic epilepsy.

    abstract::Genetic factors play a major role in the etiology of juvenile myoclonic epilepsy (JME), a common form of idiopathic generalized epilepsy, but so far, genes related to JME remain largely unknown. JME shares electroclinical features with Unverricht-Lundborg disease (progressive myoclonic epilepsy type 1; EPM1), a form o...


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    更新日期:2015-04-01 00:00:00

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    authors: Stöllberger C,Wegner C,Finsterer J

    更新日期:2011-11-01 00:00:00

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    更新日期:2007-09-01 00:00:00

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    pub_type: 杂志文章,评审


    authors: Mulley JC,Mefford HC

    更新日期:2011-03-01 00:00:00

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    pub_type: 杂志文章


    authors: Lawson JA,Vogrin S,Bleasel AF,Cook MJ,Bye AM

    更新日期:2000-11-01 00:00:00

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    pub_type: 杂志文章


    authors: Kim HD,Clancy RR

    更新日期:1997-11-01 00:00:00

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    abstract::Generalized epilepsies are treatable with a number of antiepileptic drugs (AEDs) that are effective in different seizure types and epilepsy syndromes. The mechanisms of action of these AEDs are incompletely understood but include inhibition of low-threshold calcium currents and of voltage-gated sodium channels and fac...


    pub_type: 杂志文章,评审


    authors: Berkovic SF

    更新日期:1998-01-01 00:00:00

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    pub_type: 杂志文章


    authors: Jambaqué I,Chiron C,Dulac O,Raynaud C,Syrota P

    更新日期:1993-07-01 00:00:00

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    pub_type: 杂志文章,随机对照试验


    authors: Fraser RT,Johnson EK,Lashley S,Barber J,Chaytor N,Miller JW,Ciechanowski P,Temkin N,Caylor L

    更新日期:2015-08-01 00:00:00

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    abstract:OBJECTIVE:Standard mortality ratio for suicide in patients with epilepsy is three times higher than in the general population, and such a risk remains high even after adjusting for clinical and socioeconomic factors. It is thus important to have suitable screening instruments and to implement care pathways for suicide ...


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    authors: Mula M,McGonigal A,Micoulaud-Franchi JA,May TW,Labudda K,Brandt C

    更新日期:2016-06-01 00:00:00

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    authors: Savic I,Widen L,Thorell JO,Blomqvist G,Ericson K,Roland P

    更新日期:1990-11-01 00:00:00

  • Low glycemic index treatment for seizures in Angelman syndrome.

    abstract:PURPOSE:The low glycemic index treatment (LGIT) is a high fat, limited carbohydrate diet used in the treatment of epilepsy. The purpose of this study was to assess the efficacy and tolerability of the LGIT for the treatment of refractory seizures in pediatric patients with Angelman syndrome. METHODS:A pediatric Angelm...


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    authors: Thibert RL,Pfeifer HH,Larson AM,Raby AR,Reynolds AA,Morgan AK,Thiele EA

    更新日期:2012-09-01 00:00:00

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    authors: Margaretten NC,Warren RP

    更新日期:1987-01-01 00:00:00

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    abstract::In evaluation of patients with complex partial seizures who are candidates for surgical treatment, exact definition of the epileptogenic focus is essential for a good surgical outcome. We report a new technique which permits detailed mapping of the epileptogenic activity in the basal temporal lobe and the convexity of...


    pub_type: 杂志文章


    authors: Lüders H,Hahn J,Lesser RP,Dinner DS,Morris HH 3rd,Wyllie E,Friedman L,Friedman D,Skipper G

    更新日期:1989-03-01 00:00:00

  • The effect of age on pharmacokinetics of antiepileptic drugs.

    abstract::Management of epilepsy in the elderly requires understanding of the unique biochemical and pharmacologic characteristics of this patient population. Accurate assessment of seizures and identification of epilepsy syndromes, thorough neurologic assessment to define etiology, and comprehensive evaluation of the patient's...


    pub_type: 杂志文章,评审


    authors: Willmore LJ

    更新日期:1995-01-01 00:00:00

  • Monotherapy or polytherapy for epilepsy revisited: a quantitative assessment.

    abstract::Some investigators argue that treating epilepsy with several antiepileptic drugs (AEDs) simultaneously (polytherapy) may give rise to more adverse effects than monotherapy, but this argument lacks supporting quantitative data. To reexamine this issue, we recruited a cohort of patients from the outpatients of the Speci...


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    authors: Lammers MW,Hekster YA,Keyser A,Meinardi H,Renier WO,van Lier H

    更新日期:1995-05-01 00:00:00

  • Overexpression of pregnane X and glucocorticoid receptors and the regulation of cytochrome P450 in human epileptic brain endothelial cells.

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    authors: Ghosh C,Hossain M,Solanki J,Najm IM,Marchi N,Janigro D

    更新日期:2017-04-01 00:00:00

  • Knowledge, attitude, and practice toward epilepsy among rural Tanzanian residents.

    abstract::Before a health education program can be established, one must first know what the target population believes and does with respect to the disease in question. Therefore, we performed a study among Tanzanian rural inhabitants to identify their knowledge, attitude, and practice (KAP) toward epilepsy: 3,256 heads of hou...


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    authors: Rwiza HT,Matuja WB,Kilonzo GP,Haule J,Mbena P,Mwang'ombola R,Jilek-Aall L

    更新日期:1993-11-01 00:00:00

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    更新日期:2006-01-01 00:00:00

  • Brivaracetam in Unverricht-Lundborg disease (EPM1): Results from two randomized, double-blind, placebo-controlled studies.

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    pub_type: 杂志文章,多中心研究,随机对照试验


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    更新日期:2016-02-01 00:00:00

  • Clinical neurophysiology with special reference to the electroencephalogram.

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    pub_type: 历史文章,杂志文章


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    更新日期:2009-03-01 00:00:00

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    authors: Arpino C,Gattinara GC,Piergili D,Curatolo P

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    pub_type: 杂志文章,评审


    authors: Mizrahi EM

    更新日期:1999-01-01 00:00:00

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    pub_type: 杂志文章,评审


    authors: Rheims S,Ducray F,Ryvlin P

    更新日期:2013-12-01 00:00:00

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    authors: Morris GL 3rd,Mueller WM,Yetkin FZ,Haughton VM,Hammeke TA,Swanson S,Rao SM,Jesmanowicz A,Estkowski LD,Bandettini PA

    更新日期:1994-11-01 00:00:00