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Wali A, Siddiqui F. Focal cortical dysplasia with prolonged ictal asystole, a case report. Clin Neurophysiol Pract. 2020;6:10-15doi: 10.1016/j.cnp.2020.10.002.
Wali, A., & Siddiqui, F. (2021). Focal cortical dysplasia with prolonged ictal asystole, a case report. Clinical neurophysiology practice, 610-15. https://doi.org/10.1016/j.cnp.2020.10.002
Wali, Ahmad, and Siddiqui, Fowzia. "Focal cortical dysplasia with prolonged ictal asystole, a case report." Clinical neurophysiology practice vol. 6 (2021): 10-15. doi: https://doi.org/10.1016/j.cnp.2020.10.002
Wali A, Siddiqui F. Focal cortical dysplasia with prolonged ictal asystole, a case report. Clin Neurophysiol Pract. 2020 Dec 03;6:10-15. doi: 10.1016/j.cnp.2020.10.002. eCollection 2021. PMID: 33426383; PMCID: PMC7779374.
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Clin Neurophysiol Pract. 2020 Dec 03;6:10-15. doi: 10.1016/j.cnp.2020.10.002. eCollection 2021.

Focal cortical dysplasia with prolonged ictal asystole, a case report.

Clinical neurophysiology practice

Ahmad Wali, Fowzia Siddiqui

Affiliations

  1. Department of Neurophysiology, Aga Khan University Hospital (AKUH), Karachi, Pakistan.
  2. Department of Neurology, Bolan Medical Complex Hospital, Quetta, Pakistan.
  3. Department of Neurology, Aga Khan University Hospital (AKUH), Karachi, Pakistan.

PMID: 33426383 PMCID: PMC7779374 DOI: 10.1016/j.cnp.2020.10.002

Abstract

INTRODUCTION: Cortical dysplasia carries significant morbidities such as seizures and delayed milestones. Focal cortical dysplasia (FCD) causes refractory epilepsy with various seizure types depending on the location and extent of the dysplasia. FCD in the temporal region and the insular cortex may cause ictal bradycardia (IB) and ictal asystole (IA). Video EEG (VEEG) with simultaneous EKG recording can better diagnose these cardiac abnormalities in FCD. We describe a case of refractory epilepsy. The patient's clinical seizures were usually followed by syncope. VEEG revealed frequent seizures some of which were associated with prolonged ictal asystole.

RESULTS: A 15 years old female was admitted to an epilepsy monitoring unit for VEEG. There were widespread fast abnormal discharges known as FREDs with a frequency of 16-20 Hz. She developed numerous habitual seizures and syncope. Some of these were associated with an EKG change in the form of asystole. The cardiac workup was normal. MRI revealed abnormalities in bilateral insular, temporal, and right parietal lobes.

CONCLUSION: This case highlights the significance of:●Fast rhythmic epileptiform discharges (FREDs) in cortical dysplasia.●Role of video-EEG monitoring.●Prolonged asystole and the potential role of cardiac intervention in the form of cardiac pacing and cardioneuroablation in decreasing syncope.

© 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.

Keywords: Cardiac pacing; Cardioneuroablation; Focal cortical dysplasia FCD; Focal fast rhythmic epileptiform discharges FREDs; Ictal asystole

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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