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Ictal asystole during long-term video-EEG; semiology, localization, and intervention

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journal contribution
posted on 2021-04-26, 15:25 authored by Mohamed Khalil, Arif Ali Shukralla, Ronan Kilbride, Gerrard Mullins, Peter Widdess-Walsh, Norman DelantyNorman Delanty, Hany El-NaggarHany El-Naggar
Ictal arrhythmias are disturbances of cardiac conduction that occur during clinical or electrographic seizures. Ictal asystole (IA) is rare, and its incidence can range from 0.3–0.4% in patients with epilepsy who were monitored by video-EEG (van der Lende et al., 2015). We report on ten patients (six males and four females) with an age ranging from 31 to 70 years old) who were monitored in our video-EEG (VEEG) unit over the last eight years. These patients were selected based on the history of documented ictal asystole during inpatient VEEG monitoring). In our series the mean latency from the seizure onset to the onset of ictal asystole was 22 seconds and the mean duration of the IA was 15.8 seconds. During the asystolic phase the seizures may clinically continue or syncopal signs may supervene. In our case series all the patients had either left or right temporal lobe epilepsy, six of which were lesional. We found two patterns of ictal semiology in our series. The first group of patients included five patients who experienced a rapid onset of IA in their seizure and the second group where the latency of ictal asystole was relatively late. All our cohort had a permanent pacemaker following the diagnosis, six of these patients have been event free since placement.



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Published Citation

Khalil M, Shukralla AA, Kilbride R, Mullins G, Widdess-Walsh P, Delanty N, El-Naggar H. Ictal asystole during long-term video-EEG; semiology, localization, and intervention. Epilepsy & Behavior Reports. 2021;15:100416.

Publication Date

19 November 2020

PubMed ID



  • Beaumont Hospital
  • FutureNeuro Centre
  • School of Pharmacy and Biomolecular Sciences


Elsevier BV


  • Published Version (Version of Record)