Syncope

A friend recently had an episode which necessitated numerous diagnostic tests to try to determine the cause. With no past history of TIA, heart disease, and no provocation he became dizzy, weak, confused, staggering and eventually falling down and went into a seizure that lasted 3-4 minutes. After CT scans, MRI/MRA of brain and neck, EEG, Holter monitor study, doppler ultrasound of neck, upcoming Angiogram, and possible endarterectomy, these were the findings. Cardiologist diagnosed Bradycardia from the Holter Monitor study results and recommended a pace maker. Diagnosis is pending on the carotid arteries. The MRI of the head and brain as well as the EEG were normal. A neurologist has recommended that my friend should take antiseizure medicine that is normally prescribed to control epilepsy. We have read about non-epileptic seizures that are caused by diminished cardiac output, cardiac syncope. What are the chances that this seizure was caused by the bradycardia and not epilepsy? Also how likely is a reoccurence?

[3dragons]

I am not a doctor, just a DCM patient. I do have bradycardia, and syncopial episodes (but no seizures) when combined with bigeminy. In my case, the length of time between the efficient beats is too long, so I faint. I wish I could offer advice, but all I can say  is I hope you friend finds answers soon.

[beachlover66]

Thanks for your comments. My friend has the same problem....length of time between the efficient beats is too long. When you faint do you just drop suddenly or do you experience dizziness and confusion when it's coming on? I have read that sometimes the syncope will bring on a seizure if it lasts too long. We're trying to figure out if the seizure was brought on by the syncope or if it is epileptic in nature.

[ireneo]

When I was a child I had seizures. I don't remember them of course but I do remember going through the EEG tests. It was not pleasant 50 years ago. When I got into my teens a new doctor told my Mom I had no epilepsy but my "seizures" were most likely caused by my heart arrhythmias. I can't say for sure which was correct only that I have not had any seizure activity for decades; I do know I have multiple types of arrhythmia. Was there a connection? I guess I'll never know but my brain seems to function quite normally.

[beachlover66]

Very interesting. Thanks for you comments. We really feel that my friend's "seizure" is related to his heart arrhythmia. We found an article by an Associate Professor with the  Department of Neurology at the Epilepsy Center at the University of Kansas Medical Center that confirmed our belief. This is some of what the article contained.

Convulsive syncope: Decreased cardiac output causes reduced cerebral perfusion with loss of consciousness and convulsive motor activity. In 1998, a study found that cardiovascular disease was the most common diagnosis among patients whose conditions were initially misdiagnosed as epilepsy. Using a comprehensive battery of cardiovascular tests in a population of patients diagnosed with epilepsy, in 2000 another study found alternative cardiovascular diagnoses in 41%.

This kind of goes along with what you are telling me. Thanks again.

[heart_of_mine]

You are right to question this. Many times heart rhythm disorders are misdiagnosed with Epilepsy. I have Long QT Syndrome and sometimes when we faint due to an arrhythmia we have seizures that look like epileptic seizures but really they are from a lack of oxygen in the brain from poor cardiac output. Many people are treated for Epilepsy when in fact they have a heart rhythm disorder.

When your friend had the syncope and seizure... Did he come to gradually with confusion or was he quite aware of things when he regained consciousness after the seizure? Cardiac seizures usually come on abruptly with syncope with no aura and a quick recovery once consciousness returns. It is the opposite with Epilepsy.
See if he can get a referral to a heart rhythm specialist (Electrophysiologist).

Hope this helps.

[3dragons]

I usually get dizziness beforehand, and more often than not I have a lot of pounding palpitations as a precursor. My eyes feel like they are bulging with each heart beat, and my vision goes black with the "pulse"...

Now that I am aware of what is happening, I more often than not am able to prevent fainting if I get my head lower than my heart. I've only had one blackout (without the lead up dizziness and warning) this year, and when I regained consciousness it felt just like waking up, more of a "what am I doing here?" wonderment than anything else. Mine is most definitely cardiac related, not epilepsy or any other neurological dysfunction (at least not that we are aware of!).

[beachlover66]

He came to and was a little confused. He doesn't really remember some of it but within a few hours things started coming back to him. The only thing he really doesn't remember is the few minutes just prior to the episode and the few minutes just after it.

He was referred to a heart specialist and had a pace maker inserted last week.

Thanks for your comments.