Abstracts

Ictal asystole or bradyarrythmias are recognized cardiac processes associated with certain epilepsies and are the subject of case reports and case series. Less is known about the incidence of patients originally thought to have epilepsy who ultimately are diagnosed with asystole or bradyarrythmias not associated with any seizure manifestation., All patients admitted to epilepsy monitoring units from two hospitals from 2000-2005 were retrospectively evaluated for clinically significant bradyarrythmias which explained their paroxysmal episodes of alteration of consciousness or [ldquo]convulsions[rdquo]. 550 subjects ranging from age 5 months to 81 years-old were included in the analysis. All subjects analyzed had one or more events documented with concomitant video, electroencephalographic, and electrocardiographic data. Total recording time ranged from 8 hours to 8 days. Patients with known epilepsy admitted for ictal single-photon emission computed tomography or intracranial EEG monitoring were excluded from analysis., Three patients were diagnosed with clinically significant asystole or bradyarrythmias. One patient (age 5 months) died in the hospital during an event in which she could not be resuscitated. The other two (ages 49 and 76) patients had episodes for 39 and 8 years, respectively and carried the diagnosis of medically refractory epilepsy. Both of these patients had an implantable cardiac defibrillator placed and are event-free., The incidence of patients admitted for video-EEG monitoring who are ultimately diagnosed with asystole and bradyarrythmias not associated with epilepsy is rare. However, the lack of timely diagnosis can be fatal, and epileptologists should recognize the possibility of significant cardiac arrythmias being misinterpreted as seizures., (Supported by Mayo Clinic Foundation grant to JJS, NIH 3 M01 RR00997-20S3 to JJS.)