Mr. B is 54 years old and presented with frequent, recurrent unresponsiveness and loss of muscle tone and then 10-30 s of unconsciousness. He reported dreaming but could not specify any details; however, videos showed no abnormal movements. The events were always followed by a 30 min episode of nausea and confusion with speech difficulties.
He denied any epileptic risks, with a normal EEG and brain MRI. The epilepsy monitoring unit (EMU) noted left temporal focal seizures and bradycardia, with his heart rate decreasing to 20, followed by up to 4 s pauses on the EKG. His seizures stopped after receiving a cardiac pacemaker with levetiracetam and lacosamide. Cover image: Representative tracing of a focal seizure with onset in the left frontotemporal region (open arrow) followed by bradycardia (solid arrow) with subsequent brief asystole (open square) and complaints of lightheadedness.…
