When a Seizure Isn’t a Seizure: Why Every First Seizure Needs an ECG

ECG Weekly Workout with Dr. Amal Mattu

HPI

A 34-year-old woman presents after her third witnessed episode of generalized shaking. She has already been hospitalized, undergone an unrevealing workup, and started on levetiracetam. There is one unusual feature: every episode has occurred while she was asleep. This time, someone obtains the following 12-lead ECG:

Before watching this week’s workout, review the ECG carefully and consider:

    1. What cardiac disorders can masquerade as generalized seizures?
    2. What should you specifically look for on the ECG of a patient with a first apparent seizure?
    3. Why might events occurring exclusively during sleep increase suspicion for an arrhythmic cause?
    4. What clinical features can help distinguish convulsive syncope from a true generalized seizure?