Ictal asystole: A rare cardiac manifestation of temporal lobe epilepsy, treated with epilepsy surgery

Seizures are associated with fascinatingly varied cardiac and autonomic manifestations, of which ictal tachycardia is common, and asystole and bradycardia are rare. Ictal asystole (IA), an often unsought autonomic phenomenon, occurs most commonly with temporal followed by frontal lobe seizures. Prolonged IA may lead to cerebral anoxic ischemia. As the mysteries of sudden unexplained death in epilepsy are unraveled, it is quite possible that the key to it lays within these seizure-induced cardiac rhythm abnormalities. We present a case of a young male with temporal lobe epilepsy due to left mesial temporal sclerosis with prolonged IA, which was successfully managed with epilepsy surgery.