Authors :
Presenting Author: Sanaya Daruvala, MD – Rhode Island Hospital
Ayan Purkayastha, MD – Rhode Island Hospital; Matthew Taylor, MD – Rhode Island Hospital; Wasiq Sheikh, MD – Rhode Island Hospital; Michael Wu, MD – Rhode Island Hospital; Mauricio Villamar, MD – Rhode Island Hospital; Fábio Nascimento, MD – Washington University School of Medicine; Neishay Ayub, MD – Rhode Island Hospital
Rationale:
Ictal and post-ictal asystole is an uncommon but potentially devastating complication of epilepsy. However the treatment and role of pacemakers in the management of these arrhythmias remains controversial. While some studies have shown a reduction in morbidity in ictal and post-ictal asystole following pacemaker implantation, there are no clear practice guidelines amongst the neurology and cardiology communities. This study aims to explore management practices in both the neurology and cardiology community for patients with ictal and post-ictal asystole.
Methods:
We disseminated a web-based, anonymous survey to neurologists and cardiologists caring for patients with ictal and post-ictal asystole through various national societies and social media platforms during a two week period. The survey consisted of 37 questions and was designed as a series of theoretical, fixed-response questions about clinical cases. Participants were requested to select the response option that best matched their current management practices. Approaches to various treatment modalities were assessed along with recommendations for ancillary testing and evaluation for risk of sudden unexpected death in epilepsy (SUDEP).
Results:
Data collection is ongoing, but preliminary results show that of the 44 neurologists that participated in the survey, the majority were epileptologists (44.68%) at large academic centers (72.73%). Almost 60% of the participants selected anti-seizure medications for first line treatment of ictal asystole, but only 47% of participants selected anti-seizure medications for first line treatment of post-ictal asystole. Forty percent of participants believed that post-ictal systole was associated with a higher risk of SUDEP compared to ictal asystole. When presented with a case of a 30 year old patient with medication refractory right temporal lobe epilepsy found to have ictal asystole, the majority of participants (44%) selected evaluation for epilepsy surgery as the next best step. However, if the patient had post-ictal asystole, the majority selected traditional pacemaker placement (44%). Data from the cardiologists is still in the process of being collected.
Conclusions:
Our survey demonstrated that there is a wide variability in practice patterns in the management of ictal and post-ictal asystole.
Funding: None