Interictal bradicardia with asystolic pauses up to 5.0 seconds in a patient with epilepsy – case report

    Authors

    Keywords

    epilepsy, asystole, autonomic dysfunction, sudden death

    DOI

    https://doi.org/10.15836/ccar2016.417

    Full Text

    **Background:** Partial and generalized epileptic seizures frequently cause central dysautonomia. Sympathomimetic response is seen most frequently – ictal tachycardia occurs in more than 85% of cases, ictal bradycardia in less than 2% of patients, while epileptogenic asystole is very rare, and occasionally related to the underlying cardiac condition. Antiepileptic medications can also modulate autonomic function and arrhythmogenesis. (1, 2) **Case report:** 44-year-old patient with long-lasting focal epilepsy with complex symptomatology and secondary generalization, with no previous history of heart disease, has been referred to ambulatory 24-hour Holter ECG monitoring. Sinus bradycardia with minimal heart rate of 19/min and sinus pauses up to 5.0 seconds was detected in sleep. Period of bradycardia ensued between significant technical interference caused by tonic-clonic seizures. **Conclusion:** Cardiovascular dysfunction can contribute to sudden death in epilepsy, therefore increased awareness and timely detection of concomitant arrhythmias is essential. Simultaneous video-electroencephalography and electrocardiographic monitoring is a diagnostic method of choice.

    Literature

    1. Devinsky O. Effects of seizures on autonomic and cardiovascular function. Epilepsy Curr. 2004;4(2):43–6. https://doi.org/10.1111/j.1535-7597.2004.42001.x
    2. Seeck M, Blanke O, Jallon P, Picard F, Zaim S. Symptomatic postictal cardiac asystole in a young patient with partial seizures. Europace. 2001;3:247–52. https://doi.org/10.1053/eupc.2001.0173
    Cardiologia Croatica
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    Interictal bradicardia with asystolic pauses up to 5.0 seconds in a patient with epilepsy – case report

    Extended Abstract
    Issue10-11
    Published
    Pages417
    PDF via DOIhttps://doi.org/10.15836/ccar2016.417
    epilepsy
    asystole
    autonomic dysfunction
    sudden death

    Authors

    Lada Bradić*ORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Martina Lovrić BenčićORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Tea ŠimončekORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Blanka Glavaš KonjaORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
    Marija PereminORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: lada.bradic@gmail.com

    Full Text

    Background: Partial and generalized epileptic seizures frequently cause central dysautonomia. Sympathomimetic response is seen most frequently – ictal tachycardia occurs in more than 85% of cases, ictal bradycardia in less than 2% of patients, while epileptogenic asystole is very rare, and occasionally related to the underlying cardiac condition. Antiepileptic medications can also modulate autonomic function and arrhythmogenesis. (1, 2)

    Case report: 44-year-old patient with long-lasting focal epilepsy with complex symptomatology and secondary generalization, with no previous history of heart disease, has been referred to ambulatory 24-hour Holter ECG monitoring. Sinus bradycardia with minimal heart rate of 19/min and sinus pauses up to 5.0 seconds was detected in sleep. Period of bradycardia ensued between significant technical interference caused by tonic-clonic seizures.

    Conclusion: Cardiovascular dysfunction can contribute to sudden death in epilepsy, therefore increased awareness and timely detection of concomitant arrhythmias is essential. Simultaneous video-electroencephalography and electrocardiographic monitoring is a diagnostic method of choice.

    Literature

    1. 1.
      Devinsky O. Effects of seizures on autonomic and cardiovascular function. Epilepsy Curr. 2004;4(2):43–6.DOI
    2. 2.
      Seeck M, Blanke O, Jallon P, Picard F, Zaim S. Symptomatic postictal cardiac asystole in a young patient with partial seizures. Europace. 2001;3:247–52.DOI