Abstracts

Cardiac changes during seizures may be important complications, because the possibility of producing syncope or even sudden death. However, ictal asystolia is an infrequent seizure manifestation, and most of times it follows complex partial seizures. We present a case in which the seizures were symptomatic exclusively due to the ictal asystolia: dizziness and weakness were the ictal symptoms. The patient is a right-handed 47-year-old woman with focal motor seizures since the age of 42. She had focal seizures with loss of consciousness and hemicorporal convulsions on the left side. An EEG and MRI were unremarkable. In these years she tried carbamazepine and valproate, and the frequency of these episodes was very low (one every 3-6 months). The new complain during the last year was that, approximately once a month, she may present episodes of dizziness, generalized weakness, slow speech, occasionally followed by partial disconnection. They lasted 1-2 minutes, and after the episode the patient was very weak and pallid. She was send to our center for video-EEG. She underwent a video-EEG monitoring study with a digital video-EEG system (Harmonie, Stellate, Montreal). During wakefulness she presented one typical spell. On the EEG, around 40 seconds before the abnormal sensation, rhythmic activity develops on the electrodes T4-T6, and less clearly on T2. However the symptoms appeared very late, corresponding to the time when the EKG shows bradycardia and periods without QRS complexes of 3, 4, 7 and 3 seconds. She recognised the spell as typical for the last year, being different from the initial motor seizures. Pure dizziness or weakness can be a peculiar manifestation of a focal ictal event associated to ictal asystolia. The manifestations can be related to the ictal phenomenon but in some cases they are provoked by the cardiac changes that follow the focal seizure.