Sick sinus syndrome masquerading as idiopathic primary generalized epilepsy

Idiopathic primary generalized epilepsy (IPGE) is characterized by generalized convulsions with loss of consciousness (LOC) at times associated with lateral tongue bite and loss of bladder control. Interictal EEG record shows an organized background with a 9-12 Hz posterior dominant rhythm (PDR) and generalized spike wave and polyspike wave discharges. We present here a patient whose typical spells were characterized by abrupt LOC accompanied with tonic posturing and convulsive movements and occasional bladder incontinence. Interictal EEG was reported as intermittent generalized spike wave discharges leading to initiation of levetiracetam therapy. Marked sinus bradycardia was noted during examination during inpatient video-EEG admission. A typical event captured on video-EEG with simultaneous telemetry revealed sinus arrest leading to cerebral hypoperfusion and seizure as the underlying cause of his “epilepsy”.