The association of cardiac asystole with partial seizures: Does it result from ictal or interictal activity?

Bradycardia or asystole that occur during some seizures may be life threatening as a leading cause of SUDEP. A patient with right and left temporal lobe onset seizures and preceding bardycardia or asystole is presented. He had bilateral hippocampal atrophy on MRI. The unreliability of ictal bradycardia or asystole as a lateralizing sign in patients with partial epilepsy and the role of interictal autonomic activity in heart rate changes during seizures are discussed.