Sudden falls due to seizure-induced cardiac asystole in drug-resistant focal epilepsy

Sudden, abrupt falls to the ground during focalseizures, without any associated major motormanifestations, are a well-known althoughpoorly investigated phenomenon. Pathophysiologicmechanisms may include bitemporal orfrontal involvement with subsequent bilateralspread of the epileptic discharge. Seizure relatedcardiac arrhythmias (i.e., bradycardia orasystole) may result in syncope but may not alwaysbe considered in the etiology of ictal suddenfalls. We describe three patients with drug-resistantfocal epilepsy undergoing presurgical evaluation inwhom sudden falls during focal seizures resultedfrom seizure-related cardiac asystole.