A Family History of Seizures Associated With Sudden Cardiac Deaths

Jt, Bricker; Garson, Arthur; Pc, Gillette

doi:10.1001/archpedi.1984.02140470064021

Cited by 13 publications

(5 citation statements)

References 18 publications

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“…However, patients diagnosed with epilepsy in whom cardiac channelopathies were identified usually turn out to have nonepileptic blackouts (Bricker et al, 1984;Gospe and Choy, 1989;Pacia et al, 1994;Venkataraman et al, 2001;Gavris et al, 2002). The yield for a resting ECG in patients with epilepsy without cardiac symptoms is low.…”

Section: Potential Role Of Geneticsmentioning

confidence: 99%

Effects of Seizures on Cardiac Function

Schuele

2009

Journal of Clinical Neurophysiology

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Various chronic and acute autonomic effects on the heart are seen during epileptic seizures, and some have been implicated in cases of sudden unexpected death in epilepsy (SUDEP). Chronic autonomic dysfunction, either congenital or acquired through seizures or medications, and structural changes of the heart may all predispose patients to SUDEP. Acute autonomic changes during seizures, in particular ictal bradycardia or transient ischemia, may indicate an increased and preventable risk of mortality in patients with epilepsy. However, there is no definite epidemiologic evidence associating any of the chronic or acute cardiac effects of seizures with SUDEP. Cases of SUDEP and near-SUDEP recorded during long-term electroencephalography monitoring offer some insight into the potential mechanisms leading to SUDEP. These cases suggest that autonomic instability ending in cardiorespiratory arrest may be provoked by postictal suppression rather than by ictal activation of the autonomic nervous system. Additional epidemiologic studies on high-risk populations and access to recorded cases of SUDEP may provide more details about the exact sequence of events leading to death and thus guide the development of possible preventive strategies.

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Section: Potential Role Of Geneticsmentioning

confidence: 99%

Effects of Seizures on Cardiac Function

Schuele

2009

Journal of Clinical Neurophysiology

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“…Sudden death occurred in four adults soon after discontinuation of phenytoin. 7 In one family, a 2 year old whose seizures were treated with phenytoin for 8 years became symptomatic when phenytoin was stopped. He was then diagnosed with long QT syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…A case series from 1984 described the inadvertent use of phenytoin in long QT syndrome in which two families in whom long QT syndrome was misdiagnosed as epilepsy were treated with phenytoin. Sudden death occurred in four adults soon after discontinuation of phenytoin 7 . In one family, a 2 year old whose seizures were treated with phenytoin for 8 years became symptomatic when phenytoin was stopped.…”

Section: Discussionmentioning

confidence: 99%

Use of supra‐therapeutic phenytoin for management of ventricular arrhythmias in children: Case series and literature review

Bhansali

Tan

Spilios

et al. 2022

Pacing Clinical Electrophis

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Phenytoin is a versatile drug with utility in neurological, dermatological, and even cardiac disease processes. Though phenytoin is widely available due to its excellent anti‐epileptic properties, it is now rarely used as an antiarrhythmic. Phenytoin has well‐studied sodium‐channel blocking abilities which can be taken advantage of to treat ventricular arrhythmias. Thus, it should remain in the arsenal of antiarrhythmics for any electrophysiologist. We present two cases of intractable ventricular arrhythmia in children that were controlled with phenytoin at supra‐therapeutic serum levels, preventing the need for heart transplantation.

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“…7 Exercise or emotional upset which bring on attacks of unconsciousness, cyanosis and convulsions are also noteworthy. Garson 8,9 reports the case of the mother bringing suit against her internist, her pediatrician and the coroner. Idiopathic epilepsy was diagnosed in her daughter and she was treated with phenytoin.…”

Section: Discussionmentioning

confidence: 99%

Fainting and Convulsions in Children: All is Not Epilepsy

Dammas

Gajre

Soomro

1995

Annals of Saudi Medicine

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Episodes of unconsciousness, syncope, convulsions, or vertigo are often labeled as epilepsy and antiepileptic drugs are inappropriately used after cursory examination. Cardiac causes for such attacks should always be considered and an electrocardiogram (ECG) should always be a part of the workup in such cases. A male who was having attacks of syncope, cyanosis and convulsions precipitated by exercise and emotions is described, who was previously diagnosed as having epilepsy. ECG revealed that he had a long Q-T interval and he was also deaf. His sister was also found to be deaf with long Q-T intervals in her ECG and attacks of syncope. Other members of the family also had prolonged Q-T intervals in their ECGs.Attacks of unconsciousness, syncope or vertigo can many times pose diagnostic problems. The errors in correct diagnosis, evaluation and management of such attacks are due to inadequate history and clinical examination, as well as inappropriate investigations. Such attacks are often labeled as epilepsy, an overdiagnosed condition, and the label is wrongly applied to many children. The consequences are disastrous and effects of wrong treatment may compound the problem. Jeavons 1 found that 20% of his 470 patients did not have epilepsy; of these 93 patients, 35 had syncope.The causes of syncope or nonfebrile seizures are numerous but if syncope occurs in a previously well child who presents with atypical syncope which occurs during exercise or without typical circumstances associated with vasopressor syncope (such as heat or a crowded room), then disturbances of cardiac rate and rhythm have to be considered and ECG should be a part of the workup. Too frequently, attacks of loss of consciousness are branded automatically as epilepsy and patients are put on anti-epileptic treatment. We present a case below where, after perfunctory history and examination, the child was subjected to electroencephalogram (EEG) examination, diagnosed as epilepsy, and put on carbamazepine. In actual fact, the child had a cardiac conduction defect and deafness (Jervell and Lange-Nielsen syndrome), and on further exploration, it appeared that the younger sister of this child also had the same condition, and other members of the family had prolonged Q-T intervals in their electrocardiograms. Case History

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A Family History of Seizures Associated With Sudden Cardiac Deaths

Cited by 13 publications

References 18 publications

Effects of Seizures on Cardiac Function

Effects of Seizures on Cardiac Function

Use of supra‐therapeutic phenytoin for management of ventricular arrhythmias in children: Case series and literature review

Fainting and Convulsions in Children: All is Not Epilepsy

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