Recurrent unexplained syncope may have a cerebral origin: report of 10 cases of arrhythmogenic epilepsy.
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).


OBJECTIVE
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.
Kouakam
Claude
C
Department of cardiology, arrhythmologic centre, Lille university hospital, Lille, France. c-kouakam@chru-lille.fr
Daems
Christine
C
Guédon-Moreau
Laurence
L
Delval
Arnaud
A
Lacroix
Dominique
D
Derambure
Philippe
P
Kacet
Salem
S
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D018667:Tilt-Table Test; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000927:Anticonvulsants