Background Ictal asystole is the transient cessation of cardiac electrical activity during an epileptic seizure. It has been described in association with focal seizures, most often arising from the left temporal lobe in patients with refractory epilepsy.

Case and Results of Investigations

A 31-year-old right-handed male had a first generalised seizure at work following a period of increased alcohol consumption and sleep deprivation. There was no family history of epilepsy and neurological examination was normal. Generalised sharpened discharges with polyspikes occurred in an EEG two days later. A second EEG performed three months later contained a photopar- oxysmal response followed by a generalised seizure accompanied by a 7.5-second period of asystole. Electrographically the seizure was generalised in onset, without lateralising features, although the clinical semiology was notable for some initial focal features. MRI brain did not reveal any focal abnormality. The patient was commenced on levetiracetam and has remained seizure-free since.

Discussion This is a rare case of ictal asystole in a patient with a generalised-onset seizure, and probable underlying primary generalised epilepsy.