Case Report: Lacosamide unmasking SCN5A-associated Brugada syndrome in a young female with epilepsy.

Background: Lacosamide is frequently used as a mono- or adjunctive therapy for the treatment of adults with epilepsy. Although lacosamide is known to act on both neuronal and cardiac sodium channels, potentially leading to cardiac arrhythmias, including Brugada syndrome (BrS), its adverse effects in individuals with genetic susceptibility are less understood. Case: We report a 33-year-old female with underlying epilepsy who presented to the emergency department with a four-day history of seizure clusters, and was initially treated with lacosamide therapy. During the intravenous lacosamide infusion, the patient developed sudden cardiac arrest caused by ventricular arrhythmias necessitating resuscitation. Of note, the patient had a family history of sudden cardiac death. Workup including routine laboratory results, 12-lead electrocardiogram (ECG), echocardiogram, and coronary angiogram was non-specific. However, a characteristic type 1 Brugada ECG pattern was identified by ajmaline provocation testing; thus, confirming the diagnosis of BrS. Subsequently, the genotypic diagnosis was confirmed by Sanger sequencing, which revealed a heterozygous mutation (c.2893C>T, p.Arg965Cys) in the SCN5A gene. Eventually, the patient underwent implantable cardioverter-defibrillator implantation and was discharged with full neurological recovery. Conclusion: This case highlights a rare but lethal adverse event associated with lacosamide treatment in patients with genetic susceptibility. Further research is warranted to investigate the interactions between lacosamide and SCN5A variants.

Measurement of 2,4-toluene diisocyanate concentrations by different samplers.

The standard sampling methods for toluene diisocyanate (TDI) only collect total TDI without separating the aerosol and gas phases. There are few other samplers, such as the dual filter, triple filter and annular denuder systems (ADS), which are able to sample the aerosol and gas phases simultaneously. This field study was conducted at two workplaces to access the total 2,4-TDI and the gaseous and aerosol TDI concentrations by different samplers simultaneously. In addition to the standard sampling time of 15 min, sampling was done for 30 and 60 min to study the effect of sampling time on the measured 2,4-TDI concentrations. Test results at two workplaces show that gas-phase 2,4-TDI is the predominant species and the aerosol phase concentration is very small. The measurements using various samplers show that the sampling time influences the sampled TDI concentration considerably which may be due to reaction of TDI with water vapor and polyo in the sampling process. It is evident that as sampling time increases the TDI concentration decreases. Laboratory test was also conducted using pure gas-phase 2,4-TDI to confirm the sampling time effect on the measured concentrations found in the field study.