Autonomic seizures

Raffaele Manni MD

Epilepsy & Seizures

Updated 12.06.2023
Released 12.06.2023
Expires For CME 12.06.2026

Autonomic seizures

Author: Raffaele Manni MD

See Contributor Disclosures

Editor: Solomon L Moshé MD

Autonomic seizures

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Introduction

Overview

Subjective and objective autonomic alterations frequently occur as either ictal or postictal phenomena in epileptic seizures. However, to be classified as autonomic, a seizure must present with autonomic alterations at its very onset (focal-onset autonomic seizure according to the International League Against Epilepsy [ILAE]) (47). When autonomic symptoms occur during a seizure course, the seizure should be classified according to the symptoms (motor, sensitive, cognitive, etc) that present at its onset.

Autonomic symptoms may be either only subjectively experienced or objectively observed; in both cases, they may occur with or without impairment of awareness. Autonomic symptoms may be the unique manifestations of the seizure (also called “autonomic aura”) or may be followed by symptoms other than autonomic, including bilateral tonic-clonic seizures, as a result of the spreading of the epileptic discharge. Of note, autonomic seizures causing ictal asystole of more than 5 seconds may result in loss of body tone, stiffening, or tonic-clonic movements by causing a reduced brain perfusion.

Autonomic seizures result from a perturbation of the central autonomic network due to an epileptic discharge, in most cases arising from temporal lobe mesial structures. Cardiovascular symptoms are reportedly the most frequent autonomic manifestations; however, the clinical picture of autonomic seizures is very heterogeneous, consisting of any kind of autonomic symptom.

Autonomic seizures occur very frequently in the context of mesial temporal lobe epilepsy (MTLE) and represent the unique manifestation of a peculiar epileptic syndrome in children known as Panayiotopoulos syndrome or early-onset benign occipital epilepsy, now named self-limited epilepsy with autonomic seizures (SeLEAS). This syndrome is comprehensively addressed in a separate MedLink Neurology article.

Clinical manifestations

Presentation and course

The clinical manifestations of autonomic seizures are quite heterogeneous and vary according to the cortical areas of the central autonomic network from which the epileptic discharge arises and spreads. This article describes the symptomatology of autonomic seizures according to the 2017 ILAE classification (47). A detailed description of spatial and temporal sequence of the autonomic symptoms may have localizing and lateralizing value, and it is important to preliminarily distinguish autonomic seizures from their nonepileptic mimics.

Focal autonomic seizures with cardiovascular symptoms

Ictal sinus tachycardia. Sinus tachycardia with a heart rate of more than 100 beats per minute (bpm) at rest is reported to occur as an ictal phenomenon in 71% of focal-onset seizures.

Ictal sinus tachycardia was reported to be more prevalent in seizures arising from the temporal lobe than in those arising from extratemporal areas (15) and to occur earlier in seizures arising from the hippocampal formation than in those from extrahippocampal zones (24).

The currently available data in the literature concerning the lateralizing value of ictal sinus tachycardia are still inconclusive (15).

Ictal bradyarrhythmia and ictal asystole. Sinus bradycardia (ie, hearth rate lower than 60 bpm) as an ictal autonomic epileptic phenomenon occurs less frequently than sinus tachycardia, with its prevalence ranging from 1.3% to 5.5% of the cases. It may present as mild asymptomatic sinus bradycardia or severe symptomatic bradyarrhythmia (pronounced sinus bradycardia, sinus arrest, atrioventricular block). Prolonged asystole is reportedly in only 0.32% of patients with drug-resistant epilepsy at video-EEG monitoring. Long-term monitoring studies using implantable cardiac loop recorders (61) showed that ictal asystole may not constantly occur in every seizure and may go unnoticed during short-term video-EEG. Ictal asystole may occur early (less than 1 year) or late (more than 1 year) with respect to epilepsy onset and may last less than 30 or more than 30 seconds, with the ictal asystole longer than 30 seconds being less frequent and generally associated with focal seizures evolving to bilateral tonic-clonic seizures. Treatment with sodium channel blockers or antiepileptic drugs have been reported to not increase the frequency and duration of ictal asystole (59).

Most studies indicate that ictal bradycardia is associated with epileptic discharges arising from the temporal lobe, namely from the insula, in the left hemisphere (61; 59). Ictal asystole could be either a direct consequence of the epileptic discharge affecting the limbic area of the central autonomic network or an indirect effect of a vasovagal reflex triggered by the seizure, which may trigger a vasovagal reflex. Seizures with syncopal ictal asystole are shorter than those with nonsyncopal ictal bradycardia and appear to be self-limited (61). The cerebral anoxia caused by syncope related to asystole could be a potential mechanism of seizure termination (49; 61).

In medically refractory patients with ictal asystole and related falls, cardiac pacemaker implantation should be considered as it has been proven to be effective in preventing falls (38; 59).

Focal autonomic seizures with respiratory symptoms

Ictal hyperventilation. The prevalence of hyperventilation as an ictal epileptic autonomic focal seizure is poorly defined. This is due in part to the fact that respiratory parameters are not routinely assessed during video-EEG monitoring (04). Ictal hyperventilation is more frequently overserved with epileptiform discharges arising from mesial areas than from neocortical areas of the temporal lobe (16). This difference may reflect the connectivity between the structures of the mesial temporal lobe, the hippocampus, and autonomic nuclei of the brainstem. Harvey and colleagues reported that ictal hyperventilation also occurs as a symptom of epileptic seizures arising from the frontopolar and the orbitofrontal regions (22).

First of three consecutive ictal EEG epochs an ongoing autonomic seizure during wakefulness

The EEG shows an abrupt decrease of amplitude and slowing of alpha rhythm on the occipital leads of the left hemisphere, followed by sharp theta waves on temporal-occipital leads in the same region, evolving to high-voltage spi...
Second of three consecutive ictal EEG epochs an ongoing autonomic seizure during wakefulness

The EEG shows an abrupt decrease of amplitude and slowing of alpha rhythm on the occipital leads of the left hemisphere, followed by sharp theta waves on temporal-occipital leads in the same region, evolving to high-voltage spi...
Third of three consecutive ictal EEG epochs an ongoing autonomic seizure during wakefulness

The duration of the seizure was 52 seconds from the onset of the sharp theta waves to the offset of the spike-wave activity. Shortly after the end of the seizure, EEG resumed its prior features with alpha rhythm on the occipita...

Ictal oxygen desaturation, ictal hypoventilation, and ictal central apnea. Ictal oxygen desaturations of mild (80% to 90%) to severe degrees (less than 70%) were reported in 70.8% of 79 focal seizures (32).

Ictal oxygen desaturations may be due to either hypoventilation with a parallel increase in end-tidal carbon dioxide (ETCO₂) or central apneas. Ictal oxygen desaturations significantly correlate with right temporal lobe seizure onset, with the most severe desaturations (less than 80% and less than 70%) being observed with long seizure duration and spreading of the seizure to the contralateral lobe (09; 01). Ictal central apneas were reported to precede EEG seizure onset by about 8 seconds in 54.3% of seizures and to be the only clinical manifestation in 16.5% of seizures monitored with EEG polygraphy, including breathing measurements. Of note, some ictal central apneas may go unnoticed by the patients (Lacuey et al 2017).

Autonomic seizures with gastrointestinal symptoms

Epigastric seizures. Epigastric seizures are associated with temporal lobe epilepsy in 73.6% of cases and are tendentially related to mesial temporal lobe epilepsy (MTLE) (Foldvary et al 1997; 23; Maillard et al 2004).

The lateralizing value of epigastric auras was initially stressed in some studies reporting that the epigastric aura was more frequently seen in seizures involving the nondominant temporal lobe (Gupta et al 1983; Taylor and Lochery 1987). However, more recent data suggest that epigastric auras have no lateralizing significance (23).

Ictal vomiting and retching in adults. Ictal vomiting and retching are infrequent visceral clinical seizure manifestations associated with epileptic discharges arising from a complex neuronal network involving medial and lateral parts of the temporal lobe, especially the lateral superior temporal cortex, including the insula and possibly the occipital lobes. This localization was documented by Kramer and colleagues in a study using subdural grid electrodes and by Baumgartner and colleagues in an ictal SPECT study (31; 06). However, Pietrafusa and colleagues reported episodes of ictal vomiting that were strictly related to epileptic discharges limited to mesial temporal structure (44).

Current data in the literature indicate that ictal vomiting and retching do not have any lateralizing value (Baysal-Kirac and Baykan 2015).

Ictal vomiting in children. Ictal vomiting is a more frequent event in children than in adults, and it is associated with idiopathic focal epilepsies of childhood, such as SeLEAS (43) and POLE (41). The mechanism causing vomiting in idiopathic focal epilepsies of childhood has been attributed to an infrasylvian spread of seizure to the nondominant temporal lobe (20). However, other hypotheses have been put forward. In fact, vomiting associated with occipital lobe seizures could be due to a postictal migrainous phenomena triggered by an occipital epileptic discharge (25).

Hypersalivation. Hypersalivation is a rare clinical ictal epileptic manifestation (51) indicating a mesial temporal lobe seizure onset, without lateralizing value (Janszky et al 2007).

Ictal flatulence. Ictal flatulence is a very rare ictal phenomenon. It was reported to occur in 0.6% of patients with focal epilepsies who were monitored at the Interdisciplinary Epilepsy Center of Marburg between 2006 and 2009. Ictal flatulence would indicate a temporal or insular involvement during the seizure, without a lateralizing value (56).

Ictal urge to defecate. Reported in a few case reports, this urge seems to indicate a seizure onset in the nondominant temporal lobe (57).

Autonomic seizures with cutaneous symptoms

Ictal flushing. On rare occasions, transient paroxysms of flushing, hypertension, tachycardia, and increase of catecholamine plasma levels with temporal lobe seizures have been reported (37). Furthermore, flushing is among the first symptoms in SeLEAS (54).

Ictal pallor. Pallor as an ictal symptom is reported to typically occur in SeLEAS (Panayiotopoulos 1999; Specchio et al 2010) and in temporal lobe epilepsy, mainly in patients with seizures with ictal fear and in patients with the so-called “abdominal epilepsy” featured in gastrointestinal symptoms, such as abdominal pain and nausea (18; 11).

Ictal sweating. This symptom has been anecdotally reported in various cases, such as a variant of Shapiro syndrome (Klein et al 2001), in a patient with “abdominal epilepsy” (Mendler et al 1998), and in a male patient with Ma2-positive autoimmune encephalitis associated with testicular teratoma (17). In this case, the sweating was very profuse and strictly involved the left face; the seizure-onset zone was localized to the ipsilateral (left) temporo-parietal or posterior insula.

Ictal piloerection. Ictal piloerection is reported to occur in 0.4% to 1.2% of patients with medically refractory seizures, mainly in patients with temporal lobe epilepsy (Stefan et al 2002; Rocamora et al 2003). Unilateral piloerection is most frequently associated with an ipsilateral seizure-onset zone, whereas bilateral ictal piloerection has no lateralizing value. Epileptic discharges arising from the insula or amygdala seem to underlie ictal piloerection manifestations (33).

Autonomic seizures with sexual and genital manifestations

Seizures are classified as sexual when symptoms have an erotic content and as genital when they involve the genitals without an associated erotic component. According to the 2017 ILAE seizure classification, sexual seizures can be classified as focal emotional seizures; genital seizures as focal sensory seizures; sexual automatisms as focal emotional or focal hyperkinetic seizures; and genital automatisms as focal seizures with automatisms.

The clinical manifestations of sexual seizures range from erotic thoughts and feelings to sexual arousal or orgasm and may be accompanied by viscerosensory and autonomic changes of sexual excitement. Sexual seizures occur more frequently in women than in men. They are reported to be associated with epileptic discharges in the right amygdala without spreading to the orbitofrontal, temporobasal, and insular cortex (12). Orgasmic feelings occur more frequently in seizures arising from the nondominant temporal lobe; however, they do not have absolute lateralizing significance (29; 27).

Seizures involving the genital areas consist of unpleasant, even painful, frightening or emotionally neutral somatosensory sensations in the genitals. They may be accompanied by ictal orgasm. They are associated with epileptic discharges in the parasagittal postcentral gyrus (10).

Sexual automatisms are characterized by hypermotor movements consisting of writhing, thrusting, and rhythmic movements of the pelvis, arms, and legs, sometimes in association with picking and rhythmic manipulation of the groin or genitals, exhibitionism, and masturbation. They are associated with epileptic discharges arising from the frontal lobe (62). However, genital automatisms consist of repeated grabbing, fondling, or scratching of the genitals and can be accompanied by masturbation and exhibitionistic behavior. They occur in 3% to 11.4% of patients with drug-resistant epilepsy, more frequently in men with temporal lobe seizures, and are associated with epileptic discharges in the ipsilateral hemisphere (13).

Autonomic seizures with urinary symptoms

Ictal urinary urge consists of an ictal “desire to void,” and it is a rare symptom that occurs in 0.4% to 3% of patients with temporal lobe epilepsy (28; 03), with the patient either remembering or being amnesic regarding the symptom in the postictal period.

In most patients, the seizure onset could be lateralized to the nondominant temporal lobe (03). The lateralization to the nondominant hemisphere can be explained by a hemisphere-specific representation of central bladder control. An ictal SPECT study performed during ictal urinary urge demonstrated hypoperfusion of the superior temporal gyrus and insular cortex (03). This hypothesis was further supported by PET studies in normal subjects in whom urination was associated with an activation of the right dorsal pontine tegmentum and the right inferior frontal gyrus, whereas during the filled bladder condition, the right frontal operculum or the right anterior insula were activated (08). Thus, epileptic activity within the insular cortex could be responsible for a filled bladder sensation, resulting in ictal urinary urge. Alternatively, ictal urinary urge could be mediated by the spread of epileptic activity to frontal lobe structures, ie, the right inferior frontal gyrus, which are responsible for suprapontine bladder control (05).

Differential diagnosis

Confusing conditions

A detailed and accurate reconstruction of the symptoms, their temporal sequence, duration, place, timing, triggers, and stereotypy is the starting key point to distinguish autonomic seizures from paroxysmal nonepileptic events that can mimic them. However, a definite diagnosis cannot be reached in a few cases and require instrumental investigations, such as video-EEG polygraphy or long-term EEG or non-EEG wearable monitoring devices.

Autonomic seizures frequently need to be distinguished from acute cardiorespiratory, gastrointestinal, urogenital, sexual, and psychogenic events and, in cases of sleep-related seizures, some sleep disorders, namely arousal NREM parasomnia.

Ictal sinus tachycardia, bradycardia, ictal asystole, and other peri-ictal arrhythmias should be differentiated from cardiogenic arrhythmias during wakefulness and sleep. Because cardiogenic arrhythmias may coexist in a patient, it may be very difficult to disentangle the difference in the origin of the disorders. In most cases, instrumental investigations are needed to reach a definite differential diagnosis.

As for ictal respiratory manifestations, ictal hyperventilation or shortness of breath during focal emotional seizures should be differentiated from panic attacks and acute hyperventilation of a different origin (05).

Ictal oxygen desaturations, ictal hypoventilation, and ictal central apnea must be differentiated from primary breathing disorders during wakefulness and sleep (central sleep apnea, sleep-related hypoventilation syndrome, etc).

Epigastric aura is frequently misinterpreted in patients with gastric disorders, leading to an important delay in proper diagnosis of epilepsy. The same can be said for ictal vomiting, which may be misdiagnosed as primary gastric disorders (gastritis, pyloric hypertrophy, etc) or metabolic disorders (cyclic vomiting syndrome, migraine).

Ictal urinary urge and urination should be differentiated from these symptoms in common bladder neurologic and non-neurologic disorders (cystitis, bladder cancer), prostatitis, prostatic hypertrophy, and cancer.

Sexual and genital seizures should be differentiated from psychogenic disorders with genital or sexual manifestations and, when occurring during sleep, from sexsomnia episodes, a rare subtype of NREM arousal parasomnia (48). Sexual and genital automatisms need to be differentiated from repetitive self-stimulatory behavior, which may occur in young people. Sexual epileptic automatisms occurring during sleep may need to be distinguished from sleep-related rhythmic movement disorder (35).

Associated and underlying disorders

Sudden unexpected death in epilepsy. According to the current definition, sudden unexpected death in epilepsy (SUDEP) is defined as a sudden, unexpected, nontraumatic, non-drowning death in a person with epilepsy, with an autopsy negative for either an anatomical or toxicological cause of death (52).

SUDEP is the main cause of premature death (10% to 50%) in epileptic patients (60; 53; 46). A SUDEP incidence of 2.34 per 1000 person-years was reported in a Chinese community cohort of 1562 epileptic patients followed for a 5-year period (19).

SUDEP is comprehensively covered elsewhere in MedLink Neurology. This article focuses on the potential relationship between autonomic seizures and SUDEP.

The pathogenesis of SUDEP is multifactorial, complex, and still not completely understood. However, most studies concerning interictal and ictal findings in epilepsy patients who died from SUDEP indicated that the imbalance of the neural autonomic regulatory system of cardiorespiratory functions plays a key role. Cardiac-related mechanisms include reduction in heart rate variability and prolongation of QT interval, which can lead to arrhythmias. Neural mechanisms include impairment of 5-hydroxytryptamine (serotonin) and adenosine neuromodulation (19).

A few observations in patients dying from SUDEP during epilepsy monitoring suggested a postictal breakdown of autonomic control consisting of a severe alteration of the respiratory and cardiac function, leading to a generalized EEG suppression and eventually to terminal cardiorespiratory arrest (02; 50).

Autonomic seizures are frequently seen in resistant temporal lobe epilepsy. In these cases, there have been reports of brainstem atrophy with volume loss in regions involved in autonomic control. Structural damage in these regions is thought to increase the risk of a fatal dysregulation during situations with increased autonomic activity (39).

Based on these notions, focal autonomic seizures with cardiac and respiratory dysautonomic manifestations would be expected to be at high risk of SUDEP. However, there is no evidence of increased SUDEP occurrence in patients with self-limited autonomic seizures.

Media

References

01: Bateman LM, Li CS, Seyal M. Ictal hypoxemia in localization-related epilepsy: analysis of incidence, severity and risk factors. Brain 2008;131(Pt 12):3239-45. PMID 18952672
02: Bateman LM, Spitz M, Seyal M. Ictal hypoventilation contributes to cardiac arrhythmia and SUDEP: report on two deaths in video‐EEG–monitored patients. Epilepsia 2010;51(5):916-20. PMID 20132291
03: Baumgartner C, Groppel G, Leutmezer F, et al. Ictal urinary urge indicates seizure onset in the nondominant temporal lobe. Neurology 2010;55:432-4. PMID 10932282
04: Baumgartner C, Koren J, Britto-Arias M, Schmidt S, Pirker S. Epidemiology and pathophysiology of autonomic seizures: a systematic review. Clin Auton Res 2019;29(2):137-50.** PMID 30805869
05: Baumgartner C, Lurger S, Leutmezer F. Autonomic symptoms during epileptic seizures. Epileptic Disord 2001;3(3):103-16.** PMID 11679301
06: Baumgartner C, Olbrich A, Lindinger G, et al. Regional cerebral blood flow during temporal lobe seizures associated with ictal vomiting: an ictal SPECT study in two patients. Epilepsia 1999;40(8):1085-91. PMID 10448820
07: Baysal-Kirac L, Baykan B. Current view of autonomic findings during epileptic seizures. Turk J Neurol 2015;21:147-53.
08: Blok BF, Sturms LM, Holstege G. Brain activation during micturition in women. Brain 1998;121(Pt 11):2033-42. PMID 9827764
09: Blum AS, Ives JR, Goldberger AL, et al. Oxygen desaturations triggered by partial seizures: implications for cardiopulmonary instability in epilepsy. Epilepsia 2000;41(5):536-41. PMID 10802758
10: Calleja J, Carpizo R, Berciano J. Orgasmic epilepsy. Epilepsia 1988;29(5):635-9. PMID 3409850
11: Cendes F, Andermann F, Gloor P, et al. Relationship between atrophy of the amygdala and ictal fear in temporal lobe epilepsy. Brain 1994;117(Pt 4):739-46. PMID 7922461
12: Chaton L, Chochoi M, Reyns N, Lopes R, Derambure P, Szurhaj W. Localization of an epileptic orgasmic feeling to the right amygdala, using intracranial electrodes. Cortex 2018;109:347-51. PMID 30126613
13: Dede HO, Bebek N, Gurses C, Baysal-Kirac L, Baykan B, Gokyigit A. Genital automatisms: reappraisal of a remarkable but ignored symptom of focal seizures. Epilepsy Behav 2010;80:84-9. PMID 29414563
14: Devinsky O. Diagnosis and treatment of temporal lobe epilepsy. Rev Neurol Dis 2004;1(1):2-9. PMID 16397445
15: Eggleston KS, Olin BD, Fisher RS. Ictal tachycardia: the head-heart connection. Seizure 2014;23(7):496-505. PMID 24698385
16: Foldvary N, Lee N, Thwaites G, et al. Clinical and electrographic manifestations of lesional neocortical temporal lobe epilepsy. Neurology 1997;49(3):757-63. PMID 9305337
17: Franco AC, Noachtar S, Remi J. Ictal ipsilateral sweating in focal epilepsy. Seizure 2017;50:4-5. PMID 28558270
18: Garcia-Herrero D, Fernandez-Torre JL, Barrasa J, Calleja J, Pascual J. Abdominal epilepsy in an adolescent with bilateral perisylvian polymicrogyria. Epilepsia 1988;39(12):1370-4. PMID 9860077
19: Ge Y, Ding D, Zhang Q, et al. Incidence of sudden unexpected death in epilepsy in community-based cohort in China. Epilepsy Behav 2017;76:76-83. PMID 28958777
20: Guerrini R, Ferrari AR, Battaglia A, Salvadori P, Bonanni P. Occipitotemporal seizures with ictus emeticus induced by intermittent photic stimulation. Neurology 1994;44(2):253-9. PMID 8309569
21: Gupta AK, Jeavons PM, Hughes RC, Covanis A. Aura in temporal lobe epilepsy: clinical and electroencephalographic correlation. J Neurol Neurosurg Psychiatry 1983;46(12):1079-83. PMID 6663306
22: Harvey AS, Hopkins IJ, Bowe JM, Cook DJ, Shield LK, Berkovic SF. Frontal lobe epilepsy: clinical seizure characteristics and localization with ictal 99mTc-HMPAO SPECT. Neurology 1993;43(10):1966-80. PMID 8413954
23: Henkel A, Noachtar S, Pfander M, Luders HO. The localizing value of the abdominal aura and its evolution: a study in focal epilepsies. Neurology 2002;58(2):271-6. PMID 11805256
24: Hirsch M, Altenmüller DM, Schulze-Bonhage A. Latencies from intracranial seizure onset to ictal tachycardia: a comparison to surface EEG patterns and other clinical signs. Epilepsia 2015;56(10):1639-47. PMID 26282577
25: Hockaday JM, Newton RW. Migraine and epilepsy. In: Hockaday JM, editor. Migraine in childhood. Butterworth: London, 1988:88-143.
26: Jansen K, Lagae L. Cardiac changes in epilepsy. Seizure 2010;19(8):455-60. PMID 20688543
27: Janszky J, Ebner A, Szupera Z, et al. Orgasmic aura—a report of seven cases. Seizure 2004;13(6):441-4. PMID 15276150
28: Janszky J, Fogarasi A, Toth V, et al. Peri-ictal vegetative symptoms in temporal lobe epilepsy. Epilepsy Behav 2007;11(1):125-9. PMID 17584534
29: Janszky J, Szucs A, Halasz P, et al. Orgasmic aura originates from the right hemisphere. Neurology 2002;58(2):302-4. PMID 11805263
30: Klein CJ, Silber MH, Halliwill JR, Schreiner SA, Suarez GA, Low PA. Basal forebrain malformation with hyperhidrosis and hypothermia: variant of Shapiro’s syndrome. Neurology 2001;56(2):254-6. PMID 11160966
31: Kramer RE, Lüders H, Goldstick LP, et al. Ictus emeticus: an electroclinical analysis. Neurology 1988;38(7):1048-52. PMID 3386821
32: Lacuey N, Zonjy B, Londono L, Lhatoo SD. Amygdala and hippocampus are symptomatogenic zones for central apneic seizures. Neurology 2017;88(7):701-5. PMID 28087822
33: Loddenkemper T, Kellinghaus C, Gandjour J, et al. Localising and lateralising value of ictal piloerection. J Neurol Neurosurg 2004;75(6):879-83. PMID 15146005
34: Maillard L, Vignal JP, Gavaret M, et al. Semiologic and electrophysiologic correlations in temporal lobe seizure subtypes. Epilepsia 2004;45(12):1590-9. PMID 15571517
35: Manni R, Terzaghi M. Rhythmic movements during sleep: a physiological and pathological profile. Neurol Sci 2005;26 Suppl 3:s181-5. PMID 16331393
36: Mendler MH, Sautereau D, Pillegand B, Ravon R. A case of digestive epilepsy with late diagnosis: a disease not to be disregarded. [Article in French] Gastroenterol Clin Biol 1998;22(2):235-9. PMID 9762197
37: Metz SA, Halter JB, Porte D Jr, Robertson RP. Autonomic epilepsy: clonidine blockade of paroxysmal catecholamine release and flushing. Ann Intern Med 1978;88(2):189-93. PMID 626448
38: Moseley BD, Ghearing GR, Munger TM, Britton JW. The treatment of ictal asystole with cardiac pacing. Epilepsia 2011;52(4):e16-9. PMID 21463267
39: Mueller SG, Bateman LM, Laxer KD. Evidence for brainstem network disruption in temporal lobe epilepsy and sudden unexplained death in epilepsy. Neuroimage Clin 2014;5:208-16. PMID 25068110
40: Nagai M, Hoshide S, Kario K. The insular cortex and cardiovascular system: a new insight into the brain-heart axis. J Am Soc Hypertens 2010;4(4):174-82. PMID 20655502
41: Pal DK, Ferrie C, Addis L, et al. Idiopathic focal epilepsies: the “lost tribe.” Epileptic Disord 2016;18(3):252-88. PMID 27435520
42: Panayiotopoulos CP. Early-onset benign childhood occipital seizure susceptibility syndrome: a syndrome to recognize. Epilepsia 1999;40(5):621-30.** PMID 10386532
43: Panayiotopoulos CP. Vomiting as an ictal manifestation of epileptic seizures and syndromes. J Neurol Neurosurg Psychiatry 1988;51(11):1448-51. PMID 3148690
44: Pietrafusa N, de Palma L, De Benedictis A, et al. Ictal vomiting as a sign of temporal lobe epilepsy confirmed by stereo-EEG and surgical outcome. Epilepsy Behav 2015;53:112-6. PMID 26558713
45: Rocamora R, Kurthen M, Lickfett L, Von Oertzen J, Elger CE. Cardiac asystole in epilepsy: clinical and neurophysiologic features. Epilepsia 2003;44(2):179-85. PMID 12558571
46: Ryvlin P, Nashef L, Lhatoo SD, et al. Incidence and mechanisms of cardiorespiratory arrests in epilepsy monitoring units (MORTEMUS): a retrospective study. Lancet Neurol 2013;12(10):966-77. PMID 24012372
47: Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017;58(4):512-21.** PMID 28276062
48: Schenck CH, Arnulf I, Mahowald MW. Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences). Sleep 2007;30(6):683-702. PMID 17580590
49: Schuele SU, Bermeo AC, Alexopoulos AV, Burgess RC. Anoxia-ischemia: a mechanism of seizure termination in ictal asystole. Epilepsia 2010;51(1):170-3. PMID 19490047
50: Seyal M, Hardin KA, Bateman LM. Postictal generalized EEG suppression is linked to seizure‐associated respiratory dysfunction but not postictal apnea. Epilepsia 2012;53(5):825-31. PMID 22432911
51: Shah J, Zhai H, Fuerst D, Watson C. Hypersalivation in temporal lobe epilepsy. Epilepsia 2006;47(3):644-51. PMID 16529634
52: Shankar R, Donner EJ, McLean B, Nashef L, Tomson T. Sudden unexpected death in epilepsy (SUDEP): what every neurologist should know. Epileptic Disord 2017;19:1-9. PMID 28218059
53: Shorvon S, Tomson T. Sudden unexpected death in epilepsy. Lancet 2011;378(9808):2028-38. PMID 21737136
54: Specchio N, Trivisano M, Di Ciommo V, et al. Panayiotopoulos syndrome: a clinical, EEG, and neuropsychological study of 93 consecutive patients. Epilepsia 2010;51(10):2098-107. PMID 20528983
55: Stefan H, Pauli E, Kerling F, Schwarz A, Koebnick C. Autonomic auras: left hemispheric predominance of epileptic generators of cold shivers and goose bumps? Epilepsia 2002;43:41-5. PMID 11879385
56: Strzelczyk A, Nowak M, Bauer S, et al. Localizing and lateralizing value of ictal flatulence. Epilepsy Behav 2010;17:278-82. PMID 20064748
57: Taieb G, Renard D, Labauge P, Janicot F, Briere C. Ictal urge to defecate associated with a right-sided mesial temporal cavernoma. Epilepsy Behav 2012;24:272-3. PMID 22559983
58: Taylor DC, Lochery M. Temporal lobe epilepsy: origin and significance of simple and complex auras. J Neurol Neurosurg Psychiatry 1987;50:673-81. PMID 3612148
59: Tenyi D, Gyimesi C, Kupó P, et al. Ictal asystole: a systematic review. Epilepsia 2017;58(3):356-62. PMID 27988965
60: Tomson T, Nashef L, Ryvlin P. Sudden unexpected death in epilepsy: current knowledge and future directions. Lancet Neurol 2008;7(11):1021-31. PMID 18805738
61: Van der Lende M, Surges R, Sander JW, Thijs RD. Cardiac arrhythmias during or after epileptic seizures. J Neurol Neurosurg Psychiatry 2016;87(1):69-74. PMID 26038597
62: Williamson PD, Spencer DD, Spencer SS, Novelly RA, Mattson RH. Complex partial seizures of frontal lobe origin. Ann Neurol 1985;18(4):497-504. PMID 4073842
63: References especially recommended by the author or editor for general reading.

Contributors

All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.

Author

Raffaele Manni MD

Dr. Manni of the National Institute of Neurology, IRCCS C Mondino Foundation has no relevant financial relationships to disclose.
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Editor

Solomon L Moshé MD

Dr. Moshé of Albert Einstein College of Medicine has no relevant financial relationships to disclose.
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Autonomic seizures

Associated Disorders

sudden unexpected death in epilepsy

Differential Diagnosis

cardiogenic arrhythmias
panic attacks
acute hyperventilation
central sleep apnea
sleep-related hypoventilation syndrome
- primary gastric disorders
- gastritis
- pyloric hypertrophy
- metabolic disorders
- cyclic vomiting syndrome
- migraine
- cystitis
- bladder cancer
- prostatitis
- prostatic hypertrophy
- cancer
- sexsomnia
- arousal NREM parasomnia
- sleep-related rhythmic movement disorder

Autonomic seizures

Autonomic seizures

Introduction

Overview

Clinical manifestations

Presentation and course

Focal autonomic seizures with cardiovascular symptoms

Focal autonomic seizures with respiratory symptoms

Autonomic seizures with gastrointestinal symptoms

Autonomic seizures with cutaneous symptoms

Autonomic seizures with sexual and genital manifestations

Autonomic seizures with urinary symptoms

Biological basis

Etiology and pathogenesis

Differential diagnosis

Confusing conditions

Associated and underlying disorders

Diagnostic workup

Management

Media

References

Contributors

Author

Editor

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Also in This Category

Photosensitive occipital lobe epilepsy

Intermittent explosive disorder

Pyridoxine/P5P-dependent developmental epileptic encephalopathy

Reflex seizures

Anti-LGI1 encephalitis

Self-limited (familial) neonatal epilepsy

Epilepsy with auditory features

Alcohol withdrawal seizures

Autonomic seizures

Introduction

Overview

Clinical manifestations

Presentation and course

Focal autonomic seizures with cardiovascular symptoms

Focal autonomic seizures with respiratory symptoms

Autonomic seizures with gastrointestinal symptoms

Autonomic seizures with cutaneous symptoms

Autonomic seizures with sexual and genital manifestations

Autonomic seizures with urinary symptoms

Biological basis

Etiology and pathogenesis

Differential diagnosis

Confusing conditions

Associated and underlying disorders

Diagnostic workup

Management

Media

References

Contributors

Author

Editor

This is an article preview. Start a Free Account to access the full version.

Questions or Comment?

Also in This Category

Photosensitive occipital lobe epilepsy

Intermittent explosive disorder

Pyridoxine/P5P-dependent developmental epileptic encephalopathy

Reflex seizures

Anti-LGI1 encephalitis

Self-limited (familial) neonatal epilepsy

Epilepsy with auditory features

Alcohol withdrawal seizures

This is an article preview.
Start a Free Account
to access the full version.