ABSTRACT
BACKGROUND: A woman in her sixties had been diagnosed with generalised epilepsy twenty years earlier. The diagnosis was confirmed by EEG, and an MRI scan revealed hippocampal sclerosis, which is not uncommon in patients with epilepsy. Treatment with carbamazepine was initiated. CASE PRESENTATION: Due to a rise in the patient's cholesterol, carbamazepine was replaced with oxcarbazepine. At a follow-up, the patient reported a recent episode with loss of consciousness. Unstable epilepsy was suspected and the oxcarbazepine dose increased. The patient had had a minor stroke shortly before the check-up. As part of the diagnostic workup, a 24-hour ECG was performed. On removal of the apparatus, the patient described an episode with loss of consciousness that same morning. The ECG showed asystole at that point in time due to total AV block. A pacemaker was implanted, and the patient has had no episodes since. INTERPRETATION: The patient retrospectively reported recurrent episodes with loss of consciousness over many years. The diagnosis of epilepsy was convincing, but was the heart condition linked to her epilepsy, her medication or was it a separate entity? When seizures become more frequent or change character in a previously stabilised patient with epilepsy, it is important to look for non-epileptic causes, and cardiac arrhythmias should be high on the list.
Subject(s)
Electroencephalography , Epilepsy , Benzodiazepines/therapeutic use , Carbamazepine/therapeutic use , Electrocardiography/adverse effects , Electroencephalography/adverse effects , Epilepsy/complications , Epilepsy/diagnosis , Epilepsy/drug therapy , Female , Humans , Oxcarbazepine/therapeutic use , Retrospective Studies , Syncope/etiologySubject(s)
Long QT Syndrome , Adult , Anti-Arrhythmia Agents/therapeutic use , ERG1 Potassium Channel/genetics , Epilepsy/diagnosis , Female , Humans , Long QT Syndrome/complications , Long QT Syndrome/diagnosis , Long QT Syndrome/drug therapy , Long QT Syndrome/genetics , Metoprolol/therapeutic use , Recurrence , Seizures/etiology , Unconsciousness/etiologyABSTRACT
Reading epilepsy is a form of reflex-induced seizures. Two entities are postulated as part of a clinical spectrum; one anterior variant with jaw jerks and orofacial myoclonia and another posterior variant with visual symptoms and alexia or dyslexia. We present a case with suggestible evidence of both conditions coexisting within the same patient, a finding that, to our knowledge, has not been previously reported. The diagnosis in this specific case was contributed to by the patient searching the internet.
