ICTAL SYNCOPIES - CARDIAC INNERVATION DISORDERS - A POSSIBLE EXPLANATION

We report 3 cases of an ictal sinus arrest. All patients suffered from temporal lobe epilepsy (TLE). Seizures were mon ito red with simultan eaous video-eeg during preoperative epilepsy diagnosis. One patient wi th cortical dysplasia, who frequently suffered from long lasting synco pes, had a nearly completely missing cardiac sympathetic innervation i n MIBG-SPECT ta-Iodide-Benzyle-Guanidine-single-photon-emission tomogr aphy). Cardiac investigation including long-term ECG and echocardiogra phy had shown normal findings. After epilepsy surgery the syncopal eve nts in ail patients disappeared. A dominant parasympathetic ictal stim ulus following excitation of the reticular formation might ca use the ictal bradycardia and sinus arrest. A missing sympathetic innervation, possibly occurring as fehlbildung together with cortical dysplasia,wh ich makes autoregulation impossible, might then be the explanation for sudden cardiac ictal death.