A patient is reported on with habitual episodes of collapse and loss of consciousness associated with EEG evidence of focal epileptiform discharges. Simultaneous ECG recordings disclosed 25 seconds of cardiac ventricular asystole occurring 24 seconds after the onset of electrical seizure activity. After changes to antiepileptic medication and the insertion of a permanent cardiac pacemaker he has had no further episodes. In cases of epileptic cardiac dysrhythmia, isolated EEG or ECG recording may prove insufficient and prolonged simultaneous EEG/ECG monitoring may be required.

Cardiac arrhythmias subsequent to epileptic seizures have been recognised for more than 90 years. They provoke diagnostic confusion and may be a mechanism of sudden unexplained death in epilepsy. Whereas sinus tachycardia was noted to accompany more than 90% of epileptic seizures, isolated bradycardia was seen much less commonly (only 1 of 74 seizures recorded).1 A review in 1996 of the “ictal bradycardia syndrome” showed only 15 documented cases in the literature of either bradycardia or asystole associated with seizures.2 Most patients had temporal lobe seizures. The longest duration of asystole previously reported is in a 17 year old man with temporal lobe epilepsy who sustained a 22 second pause in cardiac output. More typically the asystolic periods in documented cases are in the region of 5–10 seconds.2 …