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Cardiac Asystole and Bradycardia as a Manifestation of Left Temporal Lobe Complex Partial Seizure
- Eduardo R. Locatelli, MD;
- Jacob P. Varghese, MD;
- Ashfaq Shuaib, MD; and
- Samuel J. Potolicchio, MD
- From George Washington University, Washington, D.C.
Sudden cardiac death is almost always associated with coronary artery disease (1), but even in coronary artery disease, the autonomic nervous system plays a significant role in the genesis of arrhythmias (2). It is well established that the central nervous system can trigger sudden death by intense activation of the autonomic nervous system (3), the release of opioids, or the release of neuroactive peptides (4). Cortical stimulation studies suggest sympathetic predominance over the right hemisphere and a parasympathetic effect on the left hemisphere (5). Cortical activity, as seen in complex partial seizures with concomitant changes in heart rate, might help to validate the above findings.
We attempted to clarify the possible localization of cortical activity in patients who have asystole or bradycardia associated with complex partial seizures. We report on three such patients and review the literature on seizure-associated asystole or bradycardia monitored by simultaneous video electroencephalography-electrocardiography.
Patient 1
A 44-year-old right-handed woman with a family history of epilepsy had had staring spells and episodes of loss of consciousness since early childhood. After two recent convulsions, therapy with valproic acid and carbamazepine was started. Despite anticonvulsant treatment, she continued to have frequent 1-minute staring episodes. Results of physical …
