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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

Asystole on a tracing downloaded from ILR.
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Figure 2: Asystole on a tracing downloaded from ILR.

Mentions: A 41-year-old woman was referred for evaluation of recurrent convulsive episodes. At the age of 29 years, she began to experience episodes of sudden loss of consciousness associated with convulsive activity. Her husband described each episode as similar in nature. She would experience a prodrome of ringing in her ears followed by an abrupt loss of consciousness. She would become pale “her eyes would roll back” and she would collapse to the floor. She would then experience convulsive activity that would last between 10 seconds and 15 minutes. During episodes, she would experience urinary incontinence and on two episodes had fecal incontinence. She also suffered from multiple traumatic injuries to her face head and arms during these episodes. She underwent an extensive series of neurologic and cardiovascular evaluations at several institutions over the years yet no etiology for the events could be found. The electrocardiogram, echocardiogram, EEG, and MRI of the brain were normal. Head upright tilt table testing was normal (on two occasions), as was an exercise tolerance test. A cardiac catheterization and cardiac electrophysiology study were both normal. A sleep study was also normal. Prolonged external cardiac event monitoring was unable to capture an episode. Her recurrent unpredictable episodes caused her to become reclusive and homebound. After consultation at our institution, she underwent ILR implantation (Medtronic Reveal Dx). This demonstrated that her witnessed convulsive events were associated with prolonged episodes of cardiac asystole and complete heart block (Figure 2). Since pacemaker implantation, she has had no further convulsive episodes over a 17-month follow up period.


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

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

Asystole on a tracing downloaded from ILR.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Asystole on a tracing downloaded from ILR.
Mentions: A 41-year-old woman was referred for evaluation of recurrent convulsive episodes. At the age of 29 years, she began to experience episodes of sudden loss of consciousness associated with convulsive activity. Her husband described each episode as similar in nature. She would experience a prodrome of ringing in her ears followed by an abrupt loss of consciousness. She would become pale “her eyes would roll back” and she would collapse to the floor. She would then experience convulsive activity that would last between 10 seconds and 15 minutes. During episodes, she would experience urinary incontinence and on two episodes had fecal incontinence. She also suffered from multiple traumatic injuries to her face head and arms during these episodes. She underwent an extensive series of neurologic and cardiovascular evaluations at several institutions over the years yet no etiology for the events could be found. The electrocardiogram, echocardiogram, EEG, and MRI of the brain were normal. Head upright tilt table testing was normal (on two occasions), as was an exercise tolerance test. A cardiac catheterization and cardiac electrophysiology study were both normal. A sleep study was also normal. Prolonged external cardiac event monitoring was unable to capture an episode. Her recurrent unpredictable episodes caused her to become reclusive and homebound. After consultation at our institution, she underwent ILR implantation (Medtronic Reveal Dx). This demonstrated that her witnessed convulsive events were associated with prolonged episodes of cardiac asystole and complete heart block (Figure 2). Since pacemaker implantation, she has had no further convulsive episodes over a 17-month follow up period.

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