Ictal asystole is a dangerous complication that, although rare, can result in serious injury. To detect recurrent ictal asystole, documentation of only one or two epileptic seizures in the simultaneous video-eEG/EKG lead is not sufficient.
Background: Ictal asystole (IA) is a rare but dangerous complication and affects approximately 0.3% of patients with refractory epilepsy. It can lead to a sudden loss of muscle tone (in the sense of syncope) and thus to serious injury. IA can be missed by other seizure symptoms, which is why a simultaneous video EEG/EKG lead is necessary to make the diagnosis.
Methods: Four databases (PubMed, Web of Science, ScienceDirect, data University Clinic for Epileptology in Bonn) were searched for keywords. IA was defined as an RR interval >3 seconds and had to last at least twice as long as the previous RR interval. The final patient-based meta-analysis involved patients with epilepsy, at least one IA, and more than one seizure in a simultaneous EEG/ECG lead.
Results: A total of 80 patients from 28 studies with 182 documented IA in a total of 537 epileptic seizures were analyzed. On average, the short-term recurrence risk of IA was 40.4% (95% confidence interval (CI) 32.4-49.8%). Factors such as age, sex, type and duration of epilepsy, right/left hemispheric localization, or even duration of IA had no significant effect on the risk of recurrence. Recurrent IA was 63.8% symptomatic (CI 55.7-72.8%).
Comment: To detect recurrent IA, documentation of only one or two epileptic seizures on simultaneous video-EEG/ECG recording is not sufficient. If this is not possible over a longer period of time, an event recorder is an alternative. If adequate seizure control is not achieved with medication or, for example, epilepsy surgery, early implantation of a pacemaker can prevent severe complications from IA.
InFo NEUROLOGY & PSYCHIATRY 2017; 15(5): 28-29.
