{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T01:54:45Z","timestamp":1780624485485,"version":"3.54.1"},"reference-count":13,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of the Royal College of Physicians of Edinburgh"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>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 d\u00e9j\u00e0 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that the cardiac arrhythmia explained the entire picture, a permanent pacemaker (PPM) was inserted, and the AEDs were withdrawn in one patient and not commenced in the other.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.<\/jats:p>","DOI":"10.4997\/jrcpe.2019.209","type":"journal-article","created":{"date-parts":[[2019,6,12]],"date-time":"2019-06-12T10:51:09Z","timestamp":1560336669000},"page":"128-131","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Ictal Asystole: A Diagnostic and Management Conundrum"],"prefix":"10.1177","volume":"49","author":[{"given":"Gashirai K","family":"Mbizvo","sequence":"first","affiliation":[{"name":"PhD Clinical Research Fellow, Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK"},{"name":"PhD Clinical Research Fellow, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Derry","sequence":"additional","affiliation":[{"name":"Consultant Neurologist, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK"},{"name":"Honorary Clinical Senior Lecturer, NHS Research Fellow, Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Davenport","sequence":"additional","affiliation":[{"name":"Consultant Neurologist, Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,6,1]]},"reference":[{"key":"bibr1-jrcpe.2019.209","unstructured":"National Institute for Health and Care Excellence. Clinical guideline [CG109]: Transient loss of consciousness ('blackouts') in over 16s. 2010. https:\/\/www.nice.org.uk\/guidance\/cg109 (accessed 08\/04\/19)."},{"key":"bibr2-jrcpe.2019.209","first-page":"69","volume":"87","author":"van der Lende M","year":"2016","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"bibr3-jrcpe.2019.209","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.002546"},{"key":"bibr4-jrcpe.2019.209","author":"Kusumoto FM","year":"2018","journal-title":"Circulation"},{"key":"bibr5-jrcpe.2019.209","volume":"136","author":"Shen WK","year":"2017","journal-title":"Circulation"},{"key":"bibr6-jrcpe.2019.209","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13709"},{"key":"bibr7-jrcpe.2019.209","unstructured":"National Institute for Health and Care Excellence. Clinical guideline [CG137]: Epilepsies: diagnosis and management. 2012. https:\/\/www.nice.org.uk\/guidance\/cg137 (accessed 08\/04\/19)."},{"key":"bibr8-jrcpe.2019.209","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.1.56"},{"key":"bibr9-jrcpe.2019.209","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v3.i10.872"},{"key":"bibr10-jrcpe.2019.209","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.3949"},{"key":"bibr11-jrcpe.2019.209","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000268698.04032.bc"},{"key":"bibr12-jrcpe.2019.209","unstructured":"National Institute for Health and Care Excellence. NICE Pathways: Heart rhythm conditions overview. 2018. https:\/\/pathways.nice.org.uk\/pathways\/heart-rhythm-conditions (accessed 08\/04\/19)."},{"key":"bibr13-jrcpe.2019.209","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2018-001959"}],"container-title":["Journal of the Royal College of Physicians of Edinburgh"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/jrcpe.2019.209","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/jrcpe.2019.209","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:31:24Z","timestamp":1777617084000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4997\/jrcpe.2019.209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.4997\/jrcpe.2019.209"],"URL":"https:\/\/doi.org\/10.4997\/jrcpe.2019.209","relation":{},"ISSN":["1478-2715","2042-8189"],"issn-type":[{"value":"1478-2715","type":"print"},{"value":"2042-8189","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}