Transient Atrial Fibrillation Following Generalized Tonic-Clonic Seizure in Epileptic Patients with HIV
Abstract number :
2.004
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2021
Submission ID :
1826200
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:53 AM
Authors :
Jian Xu, MD PhD - Henry Ford Hospital; Asad Yousuf, MD – Senior Staff Neurologist, Neurology, Henry Ford Hospital; Virginia Remedio, CNP – Department of Neurology, Henry Ford Hospital; Vibhangini Wasade, MD – Epilepsy Division Head, Neurology, Henry Ford Hospital
Rationale: Cardiac arrhythmias, such as tachycardia, bradycardia or asystole have been frequently reported during or after epileptic seizures. Only a few cases of transient atrial fibrillation (AF) following generalized tonic-clonic seizures (GTCS) have been reported. Herein, we report 2 epileptic patients with a history of HIV with new onset post-ictal AF with rapid ventricular responses (RVR) following GTCS.
Methods: On two separate occasions in 2021, the two patients were admitted in the Henry Ford Epilepsy Monitoring unit (EMU) for diagnostic evaluation. Scalp video EEG monitoring was performed as anti-seizure drugs were being tapered. Patient 1 (42 years, male) who was monitored for 12 days, had a history of HIV on HAART (Biktarvy), migraines and seizures, and was on lamotrigine and lacosamide at the time of EMU admission. Patient 2 (36 years, male) with newly diagnosed multiple sclerosis, obstructive sleep apnea, also had a history of HIV on HARRT (Biktarvy), who was monitored for 6 days in EMU for nocturnal spells of concern, was taking levetiracetam at the time of EMU admission.
Results: During the EMU evaluation, in patient 1, 6 seizures were recorded (4 focal aware, 1 subclinical and 1 focal to GTCS) with EEG ictal onsets over the right temporal or right fronto-centro-temporal region. In patient 2, 7 seizures (5 focal impaired awareness, 1 subclinical and 1 focal to GTCS) were recorded with poorly defined EEG ictal onset patterns, with the earliest changes seen over the left temporal region during some seizures.
Both the patients developed AF with RVR after the only focal to GTCS that was recorded after the 6th seizure on day 5 in patient 1, and after the 4th seizure on day 4 in patient 2. Tachycardia occurred during the seizure which transitioned into AF with RVR within minutes after the seizure offset. Conversion into normal sinus rhythm (NSR) was achieved with oral metoprolol after 25 hours in patient 1. In patient 2, two doses of IV metoprolol followed by diltiazem drip converted the rhythm to NSR within 7 hours. Transthoracic echocardiogram was unremarkable in either patient. Myocardial injury with elevated troponin developed in patient 1, who also reported a family history of early onset cardiac disease. Following the incidents, patient 1 was started on apixaban and metoprolol, while patient 2 was started on metoprolol only. On EMU discharge, lacosamide was discontinued in patient 1 due to potential cardiologic side effects and lamotrigine dose was increased. In patient 2, levetiracetam dose was optimized.
Conclusions: This is the first case series that reports post-ictal AF, a rare condition after GTCS, noted in HIV patients. Appropriate management for AF should be considered after weighing the risk and benefits. Further studies with larger sample size are needed to assess any possible association between the increased risk for postictal AF after GTCS in epileptic patients with HIV.
Funding: Please list any funding that was received in support of this abstract.: None.
Neurophysiology