Document Detail


Recurrent unexplained syncope may have a cerebral origin: report of 10 cases of arrhythmogenic epilepsy.
MedLine Citation:
PMID:  19520325     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite thorough investigation, approximately 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.
Authors:
Claude Kouakam; Christine Daems; Laurence Guédon-Moreau; Arnaud Delval; Dominique Lacroix; Philippe Derambure; Salem Kacet
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Publication Detail:
Type:  Journal Article     Date:  2009-04-29
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  102     ISSN:  1875-2136     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-06-12     Completed Date:  2009-07-31     Revised Date:  2011-04-25    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  397-407     Citation Subset:  IM    
Affiliation:
Department of cardiology, arrhythmologic centre, Lille university hospital, Lille, France. c-kouakam@chru-lille.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anticonvulsants / therapeutic use
Arrhythmias, Cardiac / diagnosis,  etiology*,  therapy
Cardiac Pacing, Artificial
Echocardiography
Electrocardiography, Ambulatory
Electroencephalography
Epilepsy / complications*,  diagnosis,  therapy
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Recurrence / prevention & control
Syncope, Vasovagal / diagnosis,  etiology*,  prevention & control
Tilt-Table Test
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticonvulsants

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