Background: Recently a high prevalence of asystole was found in individuals with refractory epilepsy.
Objective: To measure the prevalence and characterize the pattern of ictal bradycardia (IB) in our cohort.
Method: We analyzed ictal heart rate (HR) and seizure localization in 69 consecutive individuals with intractable epilepsy. Ictal bradycardia was defined by HR less than 60 beat per min (bpm) and a fall of more than 30 bpm.
Results: Ictal bradycardia was observed in 1.9% of seizures and in five individuals (7.2%), who presented IB in 5.7% of their seizures. Four of them had also relative IB (a decrease of HR of more than l0 bpm) in the majority of their seizures. Four additional individuals showed relative IB.
Conclusion: Ictal bradycardia occurs more frequently than previously thought in individuals with refractory epilepsy. Recognition of individuals with small to moderate ictal HR decrease may help to identify those at greatest risk for asystole.