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We report 3 cases of an ictal sinus arrest. All patients suffered from temporal lobe epilepsy (TLE). Seizures
were monitored with simultaneous video-eeg during preoperative epilepsy diagnosis. One patient with
cortical dysplasia, who frequently suffered from long lasting syncopes, had a nearly completely missing
cardiac sympathetic innervation in MIBG-SPECT (=Meta-Iodide-Benzyle-Guanidine-single-photon-emission
tomography). Cardiac investigation including long-term ECG and echocardiography had shown normal
findings. After epilepsy surgery the syncopal events in all patients disappeared. A dominant parasympathetic
ictal stimulus following excitation of the reticular formation might cause the ictal bradycardia and sinus
arrest. A missing sympathetic innervation, possibly occurring as fehlbildung together with cortical dysplasia,
which makes autoregulation impossible, might then be the explanation for sudden cardiac ictal death.