What is Ictal Asystole?

January 10, 2011


E-Pearl of the Week

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January 10, 2011

Though cardiac arrhythmias occur commonly during epileptic seizures, seizure-induced cardiac asystole is rare. Ictal asystole has been observed most commonly in partial or secondarily generalized seizures of temporal onset. The asystole always occurs after the onset of the seizure, and is typically preceded by sinus bradycardia.

Ictal asystole can be difficult to distinguish clinically from convulsive syncope. A presyncopal prodrome, lack of initial features of a complex partial seizure, and relatively short post-ictal period suggests convulsive syncope over ictal asystole, but EEG and ECG monitoring may be necessary to establish diagnosis.


  1. Rocamora R, Kurthen M, Lickfett L, von Oertzen J, Elger CE. Cardiac asystole in epilepsy: clinical and neurophysiologic features. Epilepsia 2003;44:179–185.
  2. So NK, Sperling MR. Ictal asystole and SUDEP. Neurology 2007;69(5);423-424.

Submitted by Meredith Wicklund, MD

Dr. Wicklund reports no disclosures.

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