Syncopes liées à une épilepsie

摘要

Asystolie syncope can be related to a focal epileptic seizure. Asystolic seizure must be evoked when a patient with a focal epilepsy (mainly temporal lobe epilepsy) present a change of the ictal symptoms with acute unexplained falls. The occurrence of unexplained syncope (negative cardiac exploration, negative tilt test) must lead to a neurologic evaluation, including EEG monitoring. The diagnosis of asystolic seizure is made with simultaneous EEG and ECG monitoring. The recording of an asystole superior to 3 seconds occurring during seizure episode proved by EEG discharge confirm the diagnosis of ictal asystole. Patients with ictal asystole should have firstly antiepileptic medications optimized. If the epilepsy is drug resistant, it should be considered for epilepsy surgery. External prolonged ECG monitoring or implantable loop recorders may be helpful os diagnostic tools in patients suspected of ictal asystole and during optimization of therapy and surgery. In patients with persistent ictal asystole of more than 6 seconds in whom seizure management is optimized, implantation of a permanent pacemaker should be considered to limit morbidity and injury associated with syncope.