Summary
BackgroundDespite thorough investigation, 15–20 % of syncope cases remain unexplained. An underrecognized cause of syncope may occur when partial epileptic discharges profoundly disrupt normal cardiac rhythm, including cardiac asystole, the so-called arrhythmogenic epilepsy (AE).Aim
To report initial results of observations of AE in patients with recurrent, unexplained, traumatic and/or convulsive syncope.
Methods
Ten patients aged 49 ± 20 years (median 49.5 years; nine women) underwent complete cardiological (including ambulatory Holter electrocardiogram (ECG), echocardiography and head-up tilt test [plus electrophysiology in four patients]) and neurological (including standard electroencephalogram [EEG], computed tomography [CT] and magnetic resonance imaging scan [MRI]) assessments.
Results
After initial evaluation, neurocardiogenic syncope was suspected in six patients with tilt-induced hypotension ± bradycardia. Further evaluation (prolonged inpatient video-EEG/ECG monitoring) was undertaken because of non-diagnostic syncope or uncertainty about the diagnosis of neurocardiogenic syncope. While monitored in the neurophysiology lab, a syncopal episode similar to the spontaneous episodes recurred in all 10 patients. Cardiac asystole preceded by partial seizure of temporal onset was documented in nine patients; a second-degree atrioventricular (AV) block with a cardiac rhythm of 30 beats per minute preceded by partial seizure of temporal onset was noted in one patient. Eight patients were treated successfully with antiepileptic drugs; two were refractory to antiepileptic therapy and required pacemaker implantation. No patient had recurrent syncope during a median follow-up of 102.5 months (mean 82.2 ± 42; range 16–128 months).
Conclusions
In patients with recurrent, unexplained, traumatic and/or convulsive syncope, AE should be considered as a possible aetiology.
