We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Epileptic Asystole

Giacomo Della Marca, MD, PhD; Catello Vollono, MD, PhD; Giuseppe Bello, MD; Riccardo Maviglia, MD; Luca Montini, MD; Salvatore Mazza, MD; Alessandro Cianfoni, MD
Arch Neurol. 2008;65(6):830-831. doi:10.1001/archneur.65.6.830.
Text Size: A A A
Published online


A healthy 28 year-old man developed acute pharyngitis and fever. Three days later he experienced a prolonged generalized tonic-clonic seizure that required admission into the intensive care unit. Neurological examination findings were unremarkable. Analysis of his cerebrospinal fluid identified herpes simplex DNA. Other laboratory findings from cerebrospinal fluid analysis were a glucose level of 69 mg/dL; a protein level of 44 mg/dL; and leukocytes, 18/mm3. Results from electrocardiographic monitoring showed episodes of progressive slowing of the heart rate that lead to severe bradycardia (<30 beats/min) and sometimes brief periods of asystole. These episodes lasted 1 to 2 minutes. Interictal electrocardiographic findings were normal, in particular long QT syndrome was ruled out. Electroencephalographic monitoring revealed nonconvulsive epileptic seizures, without motor manifestations. Epileptic discharges arose from the right temporal lobe and spread contralaterally (Figure 1). These seizures recurred up to 20 times per day and were controlled with high doses of valproate sodium and carbamazepine. Magnetic resonance imaging showed a small area of abnormal signal below the right insular cortex (Figure 2). In 6 weeks the patient fully recovered without any neurological impairment. Antiepileptic treatment was continued, and he experienced no seizures in the following 6 months.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 2.

Magnetic resonance imaging scans performed 7 days after the onset of fever, the day after the observation of ictal bradycardia and asystole. A, Diffusion-weighted images. An area of slightly restricted diffusion, consistent with cytotoxic edema, is evident in the right insular ribbon (arrow). B, Axial fluid-attenuated inversion recovery scan shows an area of signal hyperintensity immediately below the right insular cortex (arrow). C and D, Axial and coronal T2-weighted scans show the same area of hyperintense signal in the right insula (arrows).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 1.

Ictal electronencephalographic (EEG) and electrocardiographic (ECG) recordings. Two hundred seconds of simultaneous EEG and ECG recordings was captured. The arrow indicates the onset of the epileptic discharge on the EEG, arising from the right temporal leads. The ECG trace shows the progressive slowing of the heart rate until the appearance of an asystole lasting 8.7 seconds, followed by spontaneous recovery of a normal ECG rhythm. No PR interval or QRS complex abnormalities appeared during the seizure.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

2 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference