Serious cardiac arrhythmias may occur with focal seizures and result in falls. Bradycardia and ictal asystole (IA) may rarely occur where a seizure has the secondary effect of transient cardiac arrest. Changes in seizure semiology reflect a syncope and often reflect the change or evolution of brain function or expression. Temporal lobe structures appear to be unique in predisposing to IA. Evolution of a seizure to atonia caused by cerebral hypoperfusion occurs about 30-40 seconds following the onset of the seizure in 0.27% of video-EEG monitoring sessions in 1 study1. Anoxia is the presumed mechanism involved in seizure termination. IA may be implicated in sudden unexplained death in epilepsy and seizure control is the treatment of choice. Following cardiology evaluation, a pacemaker was implanted in our patient with elimination of "convulsions" while he awaits epilepsy surgery. Pacemaker implantation may result in reduction in seizure-induced syncope and traumatic injuries due to falls that are associated with IA2.
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