Korean J Pediatr.  2016 Nov;59(Suppl 1):S129-S132. 10.3345/kjp.2016.59.11.S129.

Ictal sinus pause and myoclonic seizure in a child

• Kim HR
• Kim GH
• Eun SH
• Eun BL
• Byeon JH

• KMID: 2362274
• DOI: http://doi.org/10.3345/kjp.2016.59.11.S129

Abstract

Ictal tachycardia and bradycardia are common arrhythmias; however, ictal sinus pause and asystole are rare. Ictal arrhythmia is mostly reported in adults with temporal lobe epilepsy. Recently, ictal arrhythmia was recognized as a major warning sign of sudden unexpected death in epilepsy. We present an interesting case of a child with ictal sinus pause and asystole. A 27-month-old girl was hospitalized due to 5 episodes of convulsions during the past 2 days. Results of routine electroencephalography (EEG) were normal, but she experienced brief generalized tonic seizure for 3 days. During video-monitored EEG and echocardiography (ECG), she showed multiple myoclonic seizures simultaneously or independently, as well as frequent sinus pauses. After treatment with valproic acid, myoclonus and generalized tonic seizures were well controlled and only 2 sinus pauses were seen on 24-hour Holter ECG monitoring. Sinus dysfunction should be recognized on EEG, and it can sometimes be treated successfully with only antiepileptic medication.

Keyword

Asystole; Sinus pause; Electroencephalography

MeSH Terms

Adult
Arrhythmias, Cardiac
Bradycardia
Child*
Child, Preschool
Echocardiography
Electrocardiography
Electroencephalography
Epilepsy
Epilepsy, Temporal Lobe
Female
Heart Arrest
Humans
Myoclonus
Seizures*
Tachycardia
Valproic Acid
Valproic Acid