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Differentiation of convulsive syncope from epilepsy with an implantable loop recorder.

Kanjwal K, Karabin B, Kanjwal Y, Grubb BP - Int J Med Sci (2009)

Bottom Line: Failure to identify these patients delays the provision of adequate therapy while at the same time exposes the individual to the risk of injury or death.In each patient placement of an implantable loop recorder (ILR) demonstrated that their convulsive episodes were due to prolonged periods of cardiac asystole and/or complete heart block.In all patients their convulsive episodes were eliminated by permanent pacemaker implantation.

View Article: PubMed Central - PubMed

Affiliation: Electrophysiology Section, Division of Cardiology, Department of Medicine, Health Science Campus, The University of Toledo Medical Center, Toledo, Ohio 43614, USA.

ABSTRACT

Introduction: Not all convulsive episodes are due to epilepsy and a number of these have a cardiovascular cause. Failure to identify these patients delays the provision of adequate therapy while at the same time exposes the individual to the risk of injury or death.

Methods: We report on three patients who suffered from recurrent convulsive episodes, thought to be epileptic in origin, who were refractory to antiseizure therapy. Although each patient had undergone extensive evaluation, no other potential cause of his or her seizure like episodes had been uncovered. In each patient placement of an implantable loop recorder (ILR) demonstrated that their convulsive episodes were due to prolonged periods of cardiac asystole and/or complete heart block. In all patients their convulsive episodes were eliminated by permanent pacemaker implantation.

Conclusion: In patients with refractory "seizure' like episodes of convulsive activity of unknown etiology a potential cardiac rhythm disturbance should be considered and can be easily evaluated by ILR placement.

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Related in: MedlinePlus

Tracings downloaded from ILR shows prolonged asystole.
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Figure 1: Tracings downloaded from ILR shows prolonged asystole.

Mentions: A 10 year-old young man who had suffered from recurrent idiopathic “seizures” since he was one year of age was referred for evaluation. During these episodes the patient would suddenly turn pale then abruptly fall to the floor followed by convulsive activity that would last anywhere from 30 seconds to one minute. He would often be incontinent of urine and have a postictal period of confusion and disorientation lasting from ten to twenty minutes, followed by severe confusion and fatigue that would persist for the remainder of the day. The patient would experience between five and seven major episodes each year, as well as less severe episodes every one to two months. The patient had undergone extensive neurologic and cardiovascular evaluation at the several major medical centers in the US, yet an etiology for these events could not be found. The patients' electrocardiogram, echocardiogram, baseline and sleep deprived electroencephalogram (EEG), and magnetic resonance imaging (MRI) scan of the brain were all normal (each having been repeated multiple times). A head upright tilt table test was normal as was an exercise stress test. He was tried on multiple seizure medications to no avail. External event recorders were unable to capture an episode. An ILR (Medtronic Reveal XT) was inserted in the patient and one month later, the patient experienced a witnessed “mild” convulsive episode while sitting at the table. The download of the ILR showed the patient had experienced > 20 seconds of cardiac systole coincident with the episode (Figure 1). Afterward he underwent dual chamber pacemaker placement and over a ten-month follow-up has had no further convulsive events.


Differentiation of convulsive syncope from epilepsy with an implantable loop recorder.

Kanjwal K, Karabin B, Kanjwal Y, Grubb BP - Int J Med Sci (2009)

Tracings downloaded from ILR shows prolonged asystole.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2748271&req=5

Figure 1: Tracings downloaded from ILR shows prolonged asystole.
Mentions: A 10 year-old young man who had suffered from recurrent idiopathic “seizures” since he was one year of age was referred for evaluation. During these episodes the patient would suddenly turn pale then abruptly fall to the floor followed by convulsive activity that would last anywhere from 30 seconds to one minute. He would often be incontinent of urine and have a postictal period of confusion and disorientation lasting from ten to twenty minutes, followed by severe confusion and fatigue that would persist for the remainder of the day. The patient would experience between five and seven major episodes each year, as well as less severe episodes every one to two months. The patient had undergone extensive neurologic and cardiovascular evaluation at the several major medical centers in the US, yet an etiology for these events could not be found. The patients' electrocardiogram, echocardiogram, baseline and sleep deprived electroencephalogram (EEG), and magnetic resonance imaging (MRI) scan of the brain were all normal (each having been repeated multiple times). A head upright tilt table test was normal as was an exercise stress test. He was tried on multiple seizure medications to no avail. External event recorders were unable to capture an episode. An ILR (Medtronic Reveal XT) was inserted in the patient and one month later, the patient experienced a witnessed “mild” convulsive episode while sitting at the table. The download of the ILR showed the patient had experienced > 20 seconds of cardiac systole coincident with the episode (Figure 1). Afterward he underwent dual chamber pacemaker placement and over a ten-month follow-up has had no further convulsive events.

Bottom Line: Failure to identify these patients delays the provision of adequate therapy while at the same time exposes the individual to the risk of injury or death.In each patient placement of an implantable loop recorder (ILR) demonstrated that their convulsive episodes were due to prolonged periods of cardiac asystole and/or complete heart block.In all patients their convulsive episodes were eliminated by permanent pacemaker implantation.

View Article: PubMed Central - PubMed

Affiliation: Electrophysiology Section, Division of Cardiology, Department of Medicine, Health Science Campus, The University of Toledo Medical Center, Toledo, Ohio 43614, USA.

ABSTRACT

Introduction: Not all convulsive episodes are due to epilepsy and a number of these have a cardiovascular cause. Failure to identify these patients delays the provision of adequate therapy while at the same time exposes the individual to the risk of injury or death.

Methods: We report on three patients who suffered from recurrent convulsive episodes, thought to be epileptic in origin, who were refractory to antiseizure therapy. Although each patient had undergone extensive evaluation, no other potential cause of his or her seizure like episodes had been uncovered. In each patient placement of an implantable loop recorder (ILR) demonstrated that their convulsive episodes were due to prolonged periods of cardiac asystole and/or complete heart block. In all patients their convulsive episodes were eliminated by permanent pacemaker implantation.

Conclusion: In patients with refractory "seizure' like episodes of convulsive activity of unknown etiology a potential cardiac rhythm disturbance should be considered and can be easily evaluated by ILR placement.

Show MeSH
Related in: MedlinePlus