Key result
High-dose methadone therapy caused a markedly prolonged QT interval and Torsades de Pointes that masqueraded as recurrent seizures, which resolved after treatment with intravenous magnesium.
Case Report (n=1)
This case highlights the critical importance of obtaining an EKG in patients presenting with seizures, particularly those on methadone, as Torsades de Pointes can cause cerebral hypoperfusion that mimics seizure activity.
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Hypothesis-generating for torsades mimicking seizures on high-dose methadone; leaves open need for prospective ECG screening data.
The authors herein present the case of a 53-year-old female who was being treated as an outpatient for seizure disorder but was also receiving high-dose methadone therapy. She presented to the emergency department (ED) for what appeared to be a seizure and was found to have a prolonged QT interval, as well as runs of paroxysmal polymorphic ventricular tachycardia with seizure-like activity occurring during the arrhythmia. The markedly prolonged QT interval corrected after treatment with intravenous magnesium; subsequent electroencephalogram, neurology and cardiology consultations confirmed the cause of the recurrent seizure-like episodes to be secondary to the cardiotoxic effects of methadone.
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Traficante et al. (2017) conducted a case report in Methadone-induced Torsades de Pointes masquerading as seizures (n=1). Methadone was evaluated. High-dose methadone therapy caused a markedly prolonged QT interval and Torsades de Pointes that masqueraded as recurrent seizures, which resolved after treatment with intravenous magnesium.
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