Ictal sinus pause and myoclonic seizure in a child

Area of Science:

• Pediatric Neurology
• Epileptology
• Cardiology

Background:

• Ictal arrhythmias, including tachycardia and bradycardia, are common in epilepsy, particularly temporal lobe epilepsy in adults.
• Ictal arrhythmia is increasingly recognized as a critical warning sign for sudden unexpected death in epilepsy (SUDEP).
• Ictal sinus pause and asystole are rare forms of ictal arrhythmia.

Purpose of the Study:

• To present a case of a pediatric patient experiencing ictal sinus pause and asystole.
• To emphasize the importance of recognizing sinus node dysfunction during epileptic seizures in children.
• To illustrate the potential efficacy of antiepileptic drug therapy in managing these rare ictal events.

Main Methods:

• Case report of a 27-month-old girl with recurrent convulsions.
• Utilized video-electroencephalography (EEG) and electrocardiography (ECG) monitoring during seizures.
• Assessed treatment response with valproic acid.

Main Results:

• The patient exhibited multiple myoclonic seizures and frequent sinus pauses during EEG/ECG monitoring.
• Generalized tonic seizures were also observed.
• Treatment with valproic acid effectively controlled seizures and significantly reduced the frequency of sinus pauses.

Conclusions:

• Sinus node dysfunction, including pauses and asystole, can occur during epileptic seizures in children.
• Recognition of ictal sinus dysfunction on EEG is crucial.
• Antiepileptic medication may successfully treat these rare but serious ictal arrhythmias.