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Ictal asystole: an uncommon but significant cause of transient loss of consciousness—a case series
  1. Emily Cecilia Wright1,
  2. Lara Mitchell1,
  3. Russell Hewett2 and
  4. Lesley Anderton1
  1. 1Department of Medicine for the Elderly, Queen Elizabeth University Hospital Campus, Glasgow, UK
  2. 2Department of Neurology, Queen Elizabeth University Hospital Campus, Glasgow, UK
  1. Correspondence to Dr Emily Cecilia Wright; Emily.Wright{at}


Ictal bradycardia and asystole are rare, but potentially serious complications of epileptic seizures. We present a case series of three such patients diagnosed through our syncope service. For two patients, treatment with anticonvulsant therapy alone achieved symptom control. The third patient was initially managed with permanent pacemaker insertion due to detection of a significant ventricular pause. He subsequently developed more pronounced symptoms suggestive of seizure.

Ictal asystole can cause significant diagnostic challenge and management strategies remain controversial due to the overlap in presentation to cardiology and neurology services. The number of patients affected is low, impeding the formulation of an evidence base for treatment. We propose multidisciplinary working facilitated by a specialist syncope service as a means of recognising and treating this condition more effectively.

  • epilepsy and seizures
  • arrhythmias

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  • Contributors The article was researched and authored by ECW. Editorial input, the figure included, correspondence for provision of patient consent and the details of two patients were provided by LA. Editorial input and the details of the third patient were provided by LM. RH contributed specialist neurological advice in answering the reviewer’s queries and contributed one of the paragraphs added to the discussion section in response to the queries.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.