Key result
Anticonvulsant therapy alone controls symptoms in select ictal asystole cases without requiring a permanent pacemaker.
Why the study?
Ictal asystole poses a diagnostic challenge and controversial management due to overlapping presentation to cardiology and neurology services, with few affected patients impeding evidence-based treatment.
Case Report (n=3)
Ictal asystole is a rare but important cause of transient loss of consciousness that requires multidisciplinary evaluation to avoid inappropriate pacemaker implantation.
May reduce unnecessary pacing in ictal asystole; hypothesis-generating and requires prospective confirmation.
Ictal bradycardia and asystole are rare, but potentially serious complications of epileptic seizures. We present a case series of three such patients diagnosed through our syncope service. For two patients, treatment with anticonvulsant therapy alone achieved symptom control. The third patient was initially managed with permanent pacemaker insertion due to detection of a significant ventricular pause. He subsequently developed more pronounced symptoms suggestive of seizure.Ictal asystole can cause significant diagnostic challenge and management strategies remain controversial due to the overlap in presentation to cardiology and neurology services. The number of patients affected is low, impeding the formulation of an evidence base for treatment. We propose multidisciplinary working facilitated by a specialist syncope service as a means of recognising and treating this condition more effectively.
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Wright et al. (2021) conducted a case report in Ictal asystole (n=3). Anticonvulsant therapy was evaluated on Symptom control. In a case series of three patients with ictal asystole, anticonvulsant therapy alone achieved symptom control in two patients, while one initially received a permanent pacemaker.
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