{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:27:48Z","timestamp":1789990068574,"version":"4.0.1"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,12,20]],"date-time":"2013-12-20T00:00:00Z","timestamp":1387497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"\u201c Investissements d'avenir\u201d ANR-10-IAIHU-06"},{"DOI":"10.13039\/501100001677","name":"INSERM","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001677","id-type":"DOI","asserted-by":"crossref"}]},{"name":"UCB"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Ictal bradycardia and ictal asystole (<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>) are rare but severe complications of epileptic seizures. They are difficult to recognize within a seizure and their consequences remain unclear. Herein we aimed to extend the description of electrical and clinical features of seizures with<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>and\/or syncope.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Among 828 patients with epilepsy who were admitted for presurgical video\u2013electroencephalogram (<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>) monitoring evaluation between 2003 and 2012, we selected those presenting<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>and\/or syncope. We studied the electroclinical sequence of these manifestations and their correlation with electrocardiogram (<jats:styled-content style=\"fixed-case\">ECG<\/jats:styled-content>), and we compared seizures with or without<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>among the same patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine (1.08%) of 828 patients (four men, mean age 43\u00a0\u00b1\u00a06\u00a0years) showed<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>. Six patients had temporal lobe epilepsy and the others had frontal, temporooccipital, or occipital epilepsy, demonstrated by intracranial<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>in two. In these patients, 59 of 103 recorded seizures induced a reduction of heart rate (<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>), leading to<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>in 26.<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>s were mostly (80%) symptomatic, whereas ictal<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>decreases alone were not. In seizures with<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>, we identified usual ictal symptoms, and then symptoms related primarily to cerebral hypoperfusion (pallor, atonia, early myoclonic jerks, loss of consciousness, hypertonia, and fall) and secondarily to cerebral reperfusion (skin flushing, late myoclonic jerks). At 32\u00a0\u00b1\u00a018\u00a0s after the onset of the seizure, the<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>decreased progressively during 11\u00a0\u00b1\u00a06\u00a0s, reaching a sinusal pause for 13\u00a0\u00b1\u00a07\u00a0s. The duration of the<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>was strongly correlated with electroclinical consequences.<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>was longer in patients with atonia (14.8\u00a0\u00b1\u00a07 vs. 5.7\u00a0\u00b1\u00a03\u00a0s), late myoclonic jerks (15.8\u00a0\u00b1\u00a07 vs. 8\u00a0\u00b1\u00a06\u00a0s), hypertonia (19\u00a0\u00b1\u00a04.5 vs. 8.3\u00a0\u00b1\u00a05\u00a0s), and<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>hypoperfusion changes (16\u00a0\u00b1\u00a05.6 vs. 6.9\u00a0\u00b1\u00a05.5\u00a0s).<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>may induce a fall during atonia or hypertonia. Surface and intracerebral<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>recordings showed that ictal<jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>decrease and<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>often occurred when seizure activity became bilateral. Finally, we identified one patient with ictal syncopes but without<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>, presumably related to vasoplegia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>We provide a more complete description of the electroclinical features of seizures with<jats:styled-content style=\"fixed-case\">IA<\/jats:styled-content>, of the mechanism of falls, and distinguish between hypoperfusion and reperfusion symptoms of syncope. Identification of the mechanisms of syncope may improve management of patients with epilepsy. A pacemaker can be proposed, when parasympathetic activation provokes a negative chronotropic effect that leads to asystole. It is less likely to be useful when vasoplegic effects predominate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.12482","type":"journal-article","created":{"date-parts":[[2013,12,21]],"date-time":"2013-12-21T00:57:56Z","timestamp":1387587476000},"page":"146-155","source":"Crossref","is-referenced-by-count":49,"title":["Characterization of seizure\u2010induced syncopes:<scp>EEG<\/scp>,<scp>ECG<\/scp>, and clinical features"],"prefix":"10.1111","volume":"55","author":[{"given":"Vi\u2010Huong","family":"Nguyen\u2010Michel","sequence":"first","affiliation":[{"name":"Epileptology Unit Department of Neurology and Neurophysiology Assistance Publique\u2010H\u00f4pitaux de Paris Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital and Pierre et Marie Curie (Paris 6) University CRICM Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude","family":"Adam","sequence":"additional","affiliation":[{"name":"Epileptology Unit Department of Neurology and Neurophysiology Assistance 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