Epileptic Angina

Abstract

PurposeTo investigate the probable ictal origin of unexplained episodic chest pain and if possible to lateralize and localize the epileptic focus.MethodsA 14 year old boy presented with episodic short lasting localized chest pain. His cardiac and other systemic work-up were normal. MRI brain did not reveal any structural pathology. Video telemetry was done for characterization of the paroxysms.ResultsInterictal record showed left fronto-central epileptiform discharges. A left hemispheric, predominantly centroparietal ictal rhythm was identified. The possible localizations of this unusual semiology are somatosensory areas I and II, supplementary sensorimotor area, posterior insula and cingulate cortex. Patient responded remarkably to antiseizure drugs.ConclusionPain is a rare manifestation of epilepsy observed in less than 1% of patients. When present, it is usually accompanied by other focal features. This rare occurrence of epileptic seizures masquerading as angina is a novel observation.

A rare but treatable cause of recurrent chest pain - Ictal chest pain

“…In this study, PNES was the most common cause of ictal pain [2]. Pure epileptic angina as a presenting complaint was only reported by Sureshbabu et al in a 14-year-old boy [15]. Left centroparietal ictal rhythm was identified during the chest pain and the patient responded well to carbamazepine.…”

Ictal chest discomfort in a patient with temporal lobe seizures and amygdala enlargement

“…In this case, we considered that the diagnosis was delayed due to the following two points. First, chest discomfort or chest pain are rare symptoms of epilepsy [2] , [3] , [4] . Second, “circumjacent” symptoms including dystonic posturing and impaired awareness were misdiagnosed or even overlooked by the attending physicians.…”

“…A few cases of epilepsy have presented with chest manifestation as the primary symptom [2] , [3] , [4] . One patient is the only example of mTLE confirmed with comprehensive epilepsy evaluation [4] .…”

“…Epilepsy is a common chronic brain disease characterized by recurrent epileptic seizures manifest as various symptoms [1] . Epileptic seizures rarely cause paroxysmal chest discomfort [2] , [3] , [4] , usually a key feature of coronary artery disease (CAD). Several brain areas affecting autonomic function such as the mesial amygdalohippocampal region, ventromedial prefrontal cortex, insula, operculum, and anterior cingulate as well as the somatosensory area are potentially responsible areas for chest discomfort [5] .…”