Fainting and Convulsions in Children: All is Not Epilepsy

Abstract

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