Abstracts

Rationale: Transient loss of consciousness can result from either brain functional disturbances (i.e. epileptic seizures) or brain hypoperfusion, namely syncope. Early identification of cardiac asystole as a reason for syncope is of uttermost significance as insertion of a cardiac pacemaker can save the patient's life. However, cardiac asystole can rarely be provoked by epileptic seizures. The aim of this work was to bring to the attention of the neurology community subtle and unusual presentations of asystole in patients evaluated in epilepsy units. Methods: We reviewed the clinical presentation, ECG and EEG data of a series of seven patients who were evaluated in epilepsy units and were diagnosed with asystole. Results: All patients except one were implanted with pacemakers following the diagnosis of asystole and improved clinically. Three patients had primary cardiac asystole with unusual clinical manifestations, resembling epileptic seizures; one of them had been treated with anti-epileptic medications for 35 years. Three patients had ictal asystole during epileptic seizures and in one patient the diagnosis was not clear. Conclusions: Seizure-induced asystole is a rare complication of epilepsy and asystole may clinically mimic epileptic seizures. A high level of suspicion and thorough prolonged cardiac and EEG monitoring with video assistance are mandatory for reaching the correct diagnosis and providing these patients with the right life-saving treatment.