Brugada Syndrome Caused by Autonomic Dysfunction in Multiple Sclerosis

Area of Science:

• Cardiology
• Neurology
• Clinical Electrophysiology

Background:

• Multiple sclerosis (MS) is a chronic neurological disease causing deficits like gait disturbance and balance problems, increasing fall risk.
• Autonomic dysfunction in MS can lead to falls, including those with loss of consciousness.
• Brugada pattern, a type 1 electrocardiogram (ECG) finding, is associated with syncope due to cardiac dysrhythmia.

Observation:

• A rare concurrence of multiple sclerosis and type 1 Brugada pattern presents a diagnostic and therapeutic challenge.
• Both conditions can manifest with syncopal events, albeit through different mechanisms.
• MS-related neurological deficits and autonomic dysfunction may precipitate falls, mimicking cardiac syncope.

Findings:

• The study presents a case illustrating the diagnostic and therapeutic dilemma in managing MS patients with type 1 Brugada pattern and syncopal events.
• It highlights the consideration of implantable cardioverter-defibrillators (ICDs) as a preventive measure against sudden cardiac death, similar to Brugada syndrome management.
• The case report details an approach to evaluating the risks and benefits of ICD implantation in this specific patient population.

Implications:

• This case underscores the importance of a comprehensive evaluation for both neurological and cardiac causes in MS patients experiencing syncope.
• It informs clinical decision-making regarding ICD placement in MS patients presenting with a type 1 Brugada pattern, balancing syncope prevention with procedural risks.
• Further research is warranted to establish clear guidelines for managing cardiac arrhythmias in patients with multiple sclerosis.