Pearls and oy-sters: ictal syncope in a patient with temporal lobe epilepsy.

PEARLS & OY-STERS: ICTAL SYNCOPE IN A PATIENT WITH TEMPORAL LOBE EPILEPSY Nitin K. Sethi, New York: Varade et al. reported ictal syncope in a patient with temporal lobe epilepsy (TLE). The MRI revealed a right temporal-occipital cavernous angioma and the seizure showed onset in the right posterior temporal electrode (T6) on EEG, all compatible with a diagnosis of symptomatic localization-related epilepsy. It is unclear why the patient’s seizure semiology suddenly changed and why she started having syncopal episodes while earlier her seizures were characterized by impairment in consciousness and automatisms involving the upper extremities. It is possible that their patient had sick sinus syndrome coexisting with TLE aggravated by oxcarbazepine therapy. A cardiac electrophysiology study would have clarified the diagnosis in this challenging case.