Cardioinhibition can be the unique manifestation of epilepsy-like syncope

Sudden death and syncope remain frequently unexplained despite numerous investigations. Here, we report the case of a pacemaker-implanted patient who presented during video-polysomnography recording a complete atrioventricular block simultaneously with an electrical seizure. Remarkably, the patient was completely asymptomatic. He had a history of recurrent syncope previously diagnosed as convulsive vasovagal syncope with cardioinhibition. This observation challenges the current belief that epilepsy-like syncope is a partial complex seizure systematically characterized by a stereotypical clinical course and ending suddenly with syncope. Physicians should know that syncope, followed by jerking movements, of cardiac origin is frequent and often misdiagnosed as epilepsy. Conversely, and although this is a rare condition, they should also be aware of the possibility of epilepsy-like syncope, even in the absence of any other principle symptoms evocative of epilepsy.