Epilepsy and brugada syndrome: Association or uncommon presentation?

Abstract

Brugada syndrome (BrS) is a rare genetic disease, of which its clinical manifestations include, but not limited to, syncope or sudden cardiac death. A 30-year-old Bangladeshi male patient with a past medical history of epilepsy was admitted following successful resuscitation from an out of hospital cardiac arrest secondary to ventricular fibrillation. Electrocardiogram (ECG) upon admission was suggestive of BrS type I. His old medical record showed similar ECG 2 months earlier when he had presented with syncope and was diagnosed with seizure. The correlation between BrS and epilepsy has been reported in the literature, discussing whether seizure is an uncommon presentation of BrS or whether epilepsy and BrS share similar genetic mutations that have the potential to cause both arrhythmia and seizures in some patients. Patients who present with seizure and ECG suggestive of Brugada pattern should be evaluated to rule out associated or underlying cardiac arrhythmia.

Epilepsy-Induced High Affinity Blockade of the Cardiac Sodium Current INa by Lamotrigine; A Potential for Acquired Arrythmias

“…Overall, our data demonstrate that LTG, by virtue of its effect on I Na , may cause a reduction in cardiac conduction speed, excitability and APD. Those effects are consistent with clinical observations of QRS widening [ 18 , 37 , 38 , 39 ] during LTG overdose and BrS phenotypes [ 11 , 12 , 36 , 40 , 41 ] in epileptic patients. Moreover, because of the enhanced expression of nNavs sensitive to LTG during epilepsy, our data may in part explain why cardiac disturbances seem relatively benign during overdose in patients treated for depression-related illness but may become serious and potentially deadly for epileptic patients.…”

SCN5A channelopathy: arrhythmia, cardiomyopathy, epilepsy and beyond

“…In addition, a number of case reports and studies have described the identification of SCN5A mutations in patients with epilepsy, mostly co-occurring with other SCN5A -related cardiac disorders. Epileptic seizures have been reported as the initial clinical presentation in patients with BrS [117,118]. In one family, three males carrying the SCN5A -p.W1095X mutation were initially treated for epileptic seizures in childhood before being diagnosed with BrS during adulthood [119].…”

Brugada Syndrome: Warning of a Systemic Condition?

“…Unfortunately, autopsy performed on SUDEP patients does not reveal the cause of death nor any evidence related to pulmonary or cardiac pathology (75); however, SUDEP and sudden cardiac death due to cardiac arrhythmia share a few risk factors: age and sex (76). Furthermore, it has also been shown through EEG/ECG combined studies that patients with true epileptic seizures have a high prevalence (33-44%) of cardiac arrhythmias (58,(77)(78)(79)(80)(81), including, at least, LQTS, BrS, QT dispersion, sinus tachycardia, T-wave alternans, bradyarrhythmia, or asystole, sometimes through common genetic mutations (25)(26)(27)(82)(83)(84)(85)(86)(87)(88). Potential gene candidates for SUDEP include FBN1, HCN1, SCN4A, EFHC1, CACNA1A, SCN11A, and SCN10A (89).…”

“…In addition, BrS has also been associated with non-cardiac pathologies, such as epilepsy, thyroid disorders, cancer, skeletal muscle sodium channelopathies, laminopathies, and diabetes. One reason for this may be due to similar ion channel expression shared by the heart and other tissue types (24)(25)(26)(27). In fact, the most commonly found mutated gene in BrS, SCN5A (28), is expressed throughout the entire body, with the largest protein expression levels found in the plasma, heart, and pancreatic juice (29).…”