Kimizu Tomokazu, Toshikawa Hiromitsu, Kimura Sadami, Ikeda Tae, Mogami Yukiko, Yanagihara Keiko, Kishima Haruhiko, Suzuki Yasuhiro
Department of Pediatric Neurology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Child Neurol Open. 2015 Jul 21;2(3):2329048X15595818. doi: 10.1177/2329048X15595818. eCollection 2015 Jul-Sep.
Ictal bradycardia, which is considered to be one of the causes of sudden unexplained death in epilepsy, is rare. A 10-year-old girl with focal cortical dysplasia in her right centroparietal region developed transient ictal bradycardia during cluster seizures. Brain magnetic resonance imaging demonstrated a high signal intensity lesion adjacent to the focal cortical dysplasia lesion. Ictal Tc-ethyl cysteinate dimer single-photon emission computed tomography (SPECT) detected hyperperfusion in an area containing the high signal intensity lesion, which was located close to the insular cortex. Since the hyperperfusion zone observed on SPECT was considered to reflect seizure propagation, it is possible that the ictal bradycardia experienced in the present case was caused by the following mechanism: The repetitive seizure activity caused the high-intensity lesion seen on MRI to expand into the right insular cortex, which controls cardiac rhythm, resulting in ictal bradycardia.
癫痫发作时的心动过缓被认为是癫痫患者不明原因猝死的原因之一，较为罕见。一名10岁女童右侧中央顶叶区域存在局灶性皮质发育异常，在丛集性发作期间出现了短暂的发作时心动过缓。脑部磁共振成像显示在局灶性皮质发育异常病变附近有一个高信号强度病灶。发作期锝[99mTc] - 乙基半胱氨酸二聚体单光子发射计算机断层扫描（SPECT）检测到在包含高信号强度病灶的区域有血流灌注增加，该病灶位于靠近岛叶皮质处。由于SPECT上观察到的血流灌注增加区域被认为反映了癫痫发作的传播，因此本病例中经历的发作时心动过缓可能是由以下机制引起的：重复性癫痫发作活动导致MRI上所见的高强度病灶扩展至控制心律的右侧岛叶皮质，从而导致发作时心动过缓。
