pregabalin and Syncope

New-onset paroxysmal events in patients over 60 years of age are often diagnostically challenging owing to atypical presentation. Recurrent falls and transient states of confusion are especially common in the elderly population, yet their causes often remain undiagnosed due to concomitant cognitive deficits and motor impairments. We present an elderly patient with newly occurring 'blackouts' without obvious triggers and transient states of confusion for which he was amnestic. All neurological exams including brain MRI scan and routine electroencephalography (EEG) were normal. Long-term ECG monitoring using an event recorder captured an asystole during a habitual episode, leading to the diagnosis of syncope and pacemaker implantation. A subsequent video EEG monitoring performed due to ongoing unexplained confusional states revealed both bradycardia and long-lasting confusional states to be caused by unrecognised temporal lobe seizures. Ictal video EEG monitoring may play a crucial role in establishing a diagnosis of atypical temporal lobe seizures in the elderly.

Topics: Accidental Falls; Amnesia; Anticonvulsants; Confusion; Electroencephalography; Epilepsy, Temporal Lobe; Heart Arrest; Humans; Male; Middle Aged; Monitoring, Physiologic; Pacemaker, Artificial; Pregabalin; Recurrence; Syncope; Treatment Outcome; Video Recording

Long QT syndrome may lead to fatal dysrhythmia. Prolongation of QT interval due to pregabalin has been shown in rats and no data is available in humans. We report a 80-year-old female patient using pregabalin. She was presented to emergency room with syncope attacks. Her admission electrocardiography demonstrated prolonged QT interval. After excluding the possible causes of the long QT syndrome, we attributed prolonged QT interval to pregabalin therapy. After discontinuation of pregabalin QT interval returned to normal range and patient experienced no further syncope attacks. It is first time for documentation of prolonged QT due to pregabalin in humans.

Topics: Aged, 80 and over; Analgesics; Electrocardiography; Female; Humans; Long QT Syndrome; Pregabalin; Recurrence; Syncope

Onset of epilepsy can occur at any age, but it is relatively rare in the elderly. Late onset epilepsy is usually secondary to stroke, tumour, trauma or neurodegenerative disorders. A 62-year-old Indian woman presented with frequent drop attacks sometimes leading to unconsciousness and, rarely, associated with seizure. Her epilepsy work up was unremarkable. As the disease progressed, she was diagnosed as having idiopathic epilepsy, syncope or pseudo-seizure, on different occasions, and was treated at length with no response. Finally, detailed history-taking revealed her as having glossopharyngeal neuralgia leading to syncope and seizures. She subsequently improved. In clinical practice, such rare entities should also be considered for proper management of patients' ailments.

Topics: Analgesics, Non-Narcotic; Anticonvulsants; Carbamazepine; Diagnosis, Differential; Female; Glossopharyngeal Nerve; Humans; Medical History Taking; Middle Aged; Ossification, Heterotopic; Pregabalin; Seizures; Syncope; Temporal Bone; Treatment Outcome

Topics: Anticonvulsants; gamma-Aminobutyric Acid; Glossopharyngeal Nerve Diseases; Humans; Male; Middle Aged; Neck; Neuralgia; Pregabalin; Syncope