Jason H Anderson1, J Martijn Bos2, Gregory D Cascino3, Michael J Ackerman4. 1. Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota. 2. Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota. 3. Department of Neurology, Mayo Clinic, Rochester, Minnesota. 4. Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: Ackerman.michael@mayo.edu.
Abstract
BACKGROUND: Congenital long QT syndrome (LQTS) is a heritable cardiac disease whereby patients are at an increased risk for LQTS-triggered syncope, seizures, and sudden cardiac arrest. Seizure episodes are common in LQTS and most often seen in patients with type 2 LQTS (LQT2). OBJECTIVE: To determine the prevalence of electroencephalogram (EEG)-identified epileptiform activity among patients with LQTS. METHODS: A retrospective electronic medical record review of 610 patients with LQTS (250 [41%] men), evaluated between 2000 and 2012, was performed to identify (1) all patients with LQTS who presented with seizures/seizure-like episodes, (2) patients with LQTS who underwent a subsequent neurologic evaluation and EEG study, and (3) patients with LQTS and abnormal EEG recordings that showed epileptiform activity during sinus rhythm, confirming a seizure independent from cardiac arrhythmia. RESULTS: Overall, seizures/seizure-like episodes were recorded in 68 of 610 (11%) patients with LQTS. Ten patients were diagnosed with a seizure disorder by an epileptologist on the basis of the clinical findings and EEG studies, giving a prevalence of 10 of 610 (1.6%; 95% confidence interval 0.8%-3%) among patients with LQTS. A diagnosis of epilepsy was overrepresented in patients with LQT2 (7 of 190 [3.7%]) in comparison to all other LQT subgroups (3 of 420 [0.7%]; P = .0126). CONCLUSIONS: While the overall prevalence of epilepsy among patients with LQTS is low, 10 of 68 (15%) of the patients who presented with seizures/seizure-like episodes had EEG-identified epileptiform activity. Confirming earlier observational reports, epilepsy is more common in patients with LQT2, further supporting the shared pathogenetic link hypothesis of this KCNH2-encoded potassium channel that is expressed in both the heart and the brain.
BACKGROUND:Congenital long QT syndrome (LQTS) is a heritable cardiac disease whereby patients are at an increased risk for LQTS-triggered syncope, seizures, and sudden cardiac arrest. Seizure episodes are common in LQTS and most often seen in patients with type 2 LQTS (LQT2). OBJECTIVE: To determine the prevalence of electroencephalogram (EEG)-identified epileptiform activity among patients with LQTS. METHODS: A retrospective electronic medical record review of 610 patients with LQTS (250 [41%] men), evaluated between 2000 and 2012, was performed to identify (1) all patients with LQTS who presented with seizures/seizure-like episodes, (2) patients with LQTS who underwent a subsequent neurologic evaluation and EEG study, and (3) patients with LQTS and abnormal EEG recordings that showed epileptiform activity during sinus rhythm, confirming a seizure independent from cardiac arrhythmia. RESULTS: Overall, seizures/seizure-like episodes were recorded in 68 of 610 (11%) patients with LQTS. Ten patients were diagnosed with a seizure disorder by an epileptologist on the basis of the clinical findings and EEG studies, giving a prevalence of 10 of 610 (1.6%; 95% confidence interval 0.8%-3%) among patients with LQTS. A diagnosis of epilepsy was overrepresented in patients with LQT2 (7 of 190 [3.7%]) in comparison to all other LQT subgroups (3 of 420 [0.7%]; P = .0126). CONCLUSIONS: While the overall prevalence of epilepsy among patients with LQTS is low, 10 of 68 (15%) of the patients who presented with seizures/seizure-like episodes had EEG-identified epileptiform activity. Confirming earlier observational reports, epilepsy is more common in patients with LQT2, further supporting the shared pathogenetic link hypothesis of this KCNH2-encoded potassium channel that is expressed in both the heart and the brain.
Keywords:
Arrhythmia; CI; EEG; LQT1; LQT2; LQT3; LQTS; Long QT syndrome; Seizures; confidence interval; electroencephalogram; long QT syndrome; type 1 long QT syndrome; type 2 long QT syndrome; type 3 long QT syndrome
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