title: 'Refractory epilepsy': what lies beneath?
abstract: A 30-year-old woman presented to the emergency room with recurrent seizures for 5 days. She had been diagnosed with epilepsy 2 years previously but stopped treatment due to the side effects of her medications. She was now experiencing episodes every 15-30 min. While undergoing a brain MRI to investigate for structural central nervous system pathology, she experienced another episode, preceded by prodromal symptoms. Polymorphic ventricular tachycardia was noted during the event. Further investigation revealed a normal QT interval, normal electrolyte panel, normal coronaries and severe left ventricular systolic dysfunction. Cardiac MRI revealed non-ischaemic cardiomyopathy. The patient was managed with heart failure and antiarrhythmic medications and an implantable cardioverter defibrillator. She remained symptom free at 6-month follow-up. This case highlights the importance of differentiating between cardiogenic syncope and epilepsy and reiterates the importance of re-evaluating a diagnosis of epilepsy when presentation is atypical or symptoms are refractory.
authors.affiliation: Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Syedah Saira
authors.initials: SS
authors.lastname: Bokhari
authors.affiliation: Department of Biological and Biomedical Sciences, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Satwat
authors.initials: S
authors.lastname: Hashmi
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D017147:Defibrillators, Implantable; D004827:Epilepsy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D013575:Syncope / Q000000981:diagnostic imaging* / Q000628:therapy; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents