Lettre to editor: Case report of an ictal asystole as debut in new onset epilepsy.

Autor: López de Mota Sánchez D; Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain. dani.lopezdemotas@gmail.com., Maure Blesa L; Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain., Nyström Hernández AL; Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain., Olivié García L; Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain., Herranz Bárcenas A; Neurology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Jazyk: angličtina
Zdroj: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [Neurol Sci] 2024 Jul; Vol. 45 (7), pp. 3529-3530. Date of Electronic Publication: 2024 Mar 06.
DOI: 10.1007/s10072-024-07440-9
Abstrakt: The case report describes a 65-year-old man with arterial hypertension and a metallic aortic valve who presented to the emergency room for a loss of consciousness event and memory impairment. The electroencephalographic recording showed right temporal epileptiform activity followed by a 9 s asystole with quick consciousness recovery. The patient was diagnosed with right temporal epilepsy with asystole and was prescribed levetiracetam to prevent new events. A pacemaker was indicated in the follow-up for the long duration of the asystole, preventing major morbidity. Ictal asystole (IA) is a rare phenomenon of epilepsy that leads to syncope. It is observed in focal epilepsy, especially in left temporal epilepsy. Underlying cardiac pathology may facilitate IA, especially when the onset of the epilepsy is new. Knowledge of focal temporal semiology is key, concerning our case report, the memory impairment points to temporal pathology, and ictal vomiting in the non-dominant hemisphere. Anti-seizures drugs must be initiated in all patients, and there is a recommendation to avoid those with negative inotropic and arrhythmogenic effects (such as phenytoin, carbamazepine, and lacosamide). There is a discussion about pacemaker indication, however, it is highly recommended in non-controlled epilepsy and in ictal asystoles that last for more than 6 s to reduce morbidity.
(© 2024. Fondazione Società Italiana di Neurologia.)
Databáze: MEDLINE
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