Congenital long QT syndrome can masquerade as treatment-resistant epilepsy, highlighting the critical need for ECG evaluation in young patients with atypical or refractory convulsive episodes to prevent sudden cardiac death.
Supports considering congenital long QT in refractory epilepsy; leaves open whether ECG screening improves outcomes.
Long QT syndrome is a potentially lethal cardiac channelopathy that can be mistaken for epilepsy in young people. We report a 17-year-old man who was initially treated as having both daytime and nocturnal idiopathic epilepsy for 5 years. A series of electrocardiograms showed the time of the convulsive episodes, and genetic testing lead to the final diagnosis. The combined use of a beta-blocker and a pacemaker implant incompletely abolished the torsade de pointes. After an additional near-fatal event, a cardioverter defibrillator was implanted as final bridge therapy. An electrocardiogram with the correct calculation of the QT interval should be performed on all young people with a suggestive history; that is, treat refractory convulsive episodes specifically with nondiagnostic electroencephalograms.
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Chuang et al. (2009) studied this question.
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