Monthly Case

A 37-year-old female patient has suffered for 1 year from suddenly occurring sleep-bound movements of 2 min. durations. The patient herself is amnesic for these episodes. Her partner reports that loud noise – such as ringing of the alarm-clock – commonly preceded sprawling and stretching body movements. The patient was not responsive during these episodes, afterwards she was disoriented for some minutes, usually she fall asleep. In another hospital, the patient was diagnosed to suffer from epilepsy, levetiracetam treatment was initiated. Though, the episodes continued to occur unchanged every other month.

At the Epilepsy-Center Berlin-Brandenburg, video-EEG-telemetry was performed. The patient agreed that loud noise during her sleep was tried to provoke a typical episode. With a 20-sec-delay following striking of a metal bin, the stereotype movements occurred. Diagnostic, however, was not the EEG, but the simultaneously recorded ECG. This demonstrated dramatic cardiac arrhythmia characterised by ventricular tachycardia and torsades de pointes. These disturbances lasted for 2 min., then the ECG returned to regular sinus rhythm.

These investigations helped to make the correct diagnosis of syncopes, the aetiology was noise-induced cardiac arrhythmia. Detailed ECG analysis revealed polonged QT-time, genetic tests demonstrated long-QT-syndrome type II. In the following days, the patient was implanted a cardiac pacemaker in order to protect her from further life-threatening arrhythmias.

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