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Epileptic seizures commonly result in changes of cardiac rate.1-4Although tachycardias are much more frequent, ictal bradycardia and asystole may be life threatening and contribute to the syndrome of sudden unexplained death in epileptic patients.5Differentiation between primary cardiac and cerebrogenic bradyarrhythmia is possible with the use of simultaneous EEG and ECG recording. The correct identification of ictal bradycardia and asystole is important as treatment needs to consider both optimal anticonvulsant therapy and the implantation of a cardiac demand pacemaker.
We report ictal asystole in a patient with a left temporal lobe seizure identified by simultaneous ECG and scalp EEG recording.
Case history
A 74 year old Malay man was first admitted in January 1992 to the Neurosurgery Department for evacuation of bilateral chronic subdural haematomas sustained after several accidental falls. Recovery was uneventful until July 1992, when he was admitted for a possible seizure. Brain CT disclosed a right cerebral peduncular infarct. A clinical diagnosis of post-traumatic epilepsy was made, and he was started on 300 mg phenytoin at night. Over the next 5 years, he had one seizure, whereas between 1997 and 1998, he had four seizures. The four were attributed to poor compliance with medications.
In June 1999, he was admitted to the Neurology Department after another generalised tonic-clonic seizure. Neurological and cardiac examination were unremarkable. Clinically, he …