Ictal asystole with reduced cardiac sympathetic function in new-onset symptomatic epilepsy

Abstract

SUMMARY Introduction. So far, cardiac sympathetic dysfunction, demonstrated in pharmacoresistant epilepsy patients with ictal bradycardia or asystole by I-123 metaiodobenzylguanidine (I-123 MIBG) imaging has been attributed to repeated occurrence of seizure activity. Aim. Discussion of the mechanisms of cardiac sympathetic dysfunction associated with ictal asystole under consideration of a case with new onset epilepsy. Materials and methods. We describe the occurrence of a cardiac asystole during a complex-partial seizure in an antiepileptic-drug-naïve patient with new-onset symptomatic epilepsy. Results. MIBG imaging showed reduced tracer accumulation in cardiac sympathetic nerve endings in this patient with right parietotemporal glioblastoma. Discussion and Conclusion. To our knowledge, this is the first report of impaired cardiac sympathetic function in new-onset symptomatic epilepsy without antiepileptic drug treatment. MIBG imaging should be considered in patients with ictal bradycardia or asystole.