Sick sinus syndrome masquerading as idiopathic primary generalized epilepsy

Abstract

Idiopathic primary generalized epilepsy (IPGE) is characterized by generalized convulsions with loss of consciousness (LOC) at times associated with lateral tongue bite and loss of bladder control. Interictal EEG record shows an organized background with a 9-12 Hz posterior dominant rhythm (PDR) and generalized spike wave and polyspike wave discharges. We present here a patient whose typical spells were characterized by abrupt LOC accompanied with tonic posturing and convulsive movements and occasional bladder incontinence. Interictal EEG was reported as intermittent generalized spike wave discharges leading to initiation of levetiracetam therapy. Marked sinus bradycardia was noted during examination during inpatient video-EEG admission. A typical event captured on video-EEG with simultaneous telemetry revealed sinus arrest leading to cerebral hypoperfusion and seizure as the underlying cause of his “epilepsy”.

Keywords

• Sick sinus syndrome
• sino-atrial arrest
• seizure
• idiopathic generalized epilepsy

References

1. Adán V, Crown LA. Diagnosis and treatment of sick sinus syndrome. Am Fam Physician 2003; 67: 172517
2. Keller KB, Lemberg L. The sick sinus syndrome. Am J Crit Care 2006; 15: 226-229.
3. Sigurd B, Sandİe E. Management of Stokes-Adams syndrome. Cardiology 1990; 77: 195-208.
4. French LK, McKeown NJ, Hendrickson RG. Complete heart block and death following lamotrigin e overdose. Clin Toxicol (Phila) 2011; 49: 330-333.