Ictal asystole: a diagnostic and management conundrum
We report two cases of adults presenting with transient loss of consciousness (TLoC) followed by a rapid recovery. Careful history taking revealed a stereotyped prodrome of déjà vu, raising the possibility of these events being focal seizures rather than syncope. The patients were commenced on antie...
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doaj-85b7d7aa747e450794bcf0fd0e662c712020-11-24T20:55:57ZengRoyal College of Physicians of EdinburghThe Journal of the Royal College of Physicians of Edinburgh1478-27152042-81892019-06-0149212813110.4997/JRCPE.2019.209Ictal asystole: a diagnostic and management conundrumGashirai K MbizvoChris DerryRichard DavenportWe report two cases of adults presenting with transient loss of consciousness (TLoC) followed by a rapid recovery. Careful history taking revealed a stereotyped prodrome of déjà vu, raising the possibility of these events being focal seizures rather than syncope. The patients were commenced on antiepileptic drugs (AEDs) at the same time as having cardiac monitoring organised. This confirmed asystole during the seizure symptoms, resulting in TLoC. It was assumed that the cardiac arrhythmia explained the entire picture, a permanent pacemaker (PPM) was inserted, and the AEDs were withdrawn in one patient and not commenced in the other. However, they both subsequently presented with worsening seizures, including generalised tonic–clonic seizures, despite a functioning pacemaker. The seizures improved on restarting AEDs. The cases illustrate the diagnostic and management difficulties of patients presenting with ictal asystole, a condition that requires input from various medical specialities. There is no strong evidence base for the management of ictal asystole, but we favour a combined approach of AEDs and PPM insertion.https://www.rcpe.ac.uk/college/journal/ictal-asystole-diagnostic-and-management-conundrumcardiac pacingepilepsyictal asystoleseizuressyncopeTransient loss of consciousness |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gashirai K Mbizvo Chris Derry Richard Davenport |
spellingShingle |
Gashirai K Mbizvo Chris Derry Richard Davenport Ictal asystole: a diagnostic and management conundrum The Journal of the Royal College of Physicians of Edinburgh cardiac pacing epilepsy ictal asystole seizures syncope Transient loss of consciousness |
author_facet |
Gashirai K Mbizvo Chris Derry Richard Davenport |
author_sort |
Gashirai K Mbizvo |
title |
Ictal asystole: a diagnostic and management conundrum |
title_short |
Ictal asystole: a diagnostic and management conundrum |
title_full |
Ictal asystole: a diagnostic and management conundrum |
title_fullStr |
Ictal asystole: a diagnostic and management conundrum |
title_full_unstemmed |
Ictal asystole: a diagnostic and management conundrum |
title_sort |
ictal asystole: a diagnostic and management conundrum |
publisher |
Royal College of Physicians of Edinburgh |
series |
The Journal of the Royal College of Physicians of Edinburgh |
issn |
1478-2715 2042-8189 |
publishDate |
2019-06-01 |
description |
We report two cases of adults presenting with transient loss of consciousness (TLoC) followed by a rapid recovery. Careful history taking revealed a stereotyped prodrome of déjà vu, raising the possibility of these events being focal seizures rather than syncope. The patients were commenced on antiepileptic drugs (AEDs) at the same time as having cardiac monitoring organised. This confirmed asystole during the seizure symptoms, resulting in TLoC. It was assumed that the cardiac arrhythmia explained the entire picture, a permanent pacemaker (PPM) was inserted, and the AEDs were withdrawn in one patient and not commenced in the other. However, they both subsequently presented with worsening seizures, including generalised tonic–clonic seizures, despite a functioning pacemaker. The seizures improved on restarting AEDs. The cases illustrate the diagnostic and management difficulties of patients presenting with ictal asystole, a condition that requires input from various medical specialities. There is no strong evidence base for the management of ictal asystole, but we favour a combined approach of AEDs and PPM insertion. |
topic |
cardiac pacing epilepsy ictal asystole seizures syncope Transient loss of consciousness |
url |
https://www.rcpe.ac.uk/college/journal/ictal-asystole-diagnostic-and-management-conundrum |
work_keys_str_mv |
AT gashiraikmbizvo ictalasystoleadiagnosticandmanagementconundrum AT chrisderry ictalasystoleadiagnosticandmanagementconundrum AT richarddavenport ictalasystoleadiagnosticandmanagementconundrum |
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