The importance of ECG in first seizure assessment

Regarding the cardiological syndromes mentioned in this overview of first seizure management,1 I would like to highlight that electrocardiography (ECG) rather than electroencephalography is mandatory for the identification of potentially fatal arrhythmias. In addition, Brugada syndrome is not classically associated with long QT syndrome but with ST elevation in leads V1-V3, right bundle branch block, and potential sudden death from ventricular fibrillation.2 Romano Ward syndrome is a form of autosomal dominant congenital long QT syndrome (associated with normal hearing), and Jervell and Lange Neilsen syndrome is autosomal recessive and associated with deafness.2 Acquired causes of long QT syndrome include drugs such as pimozide, thioridazine, terfenadine, ketoconazole; metabolic disorders such as hypokalaemia, hypomagnesaemia; and neurosurgical disorders such as subarachnoid haemorrhage.2

When an electrocardiogram or rhythm strip is recorded during electroencephalographic monitoring, this should also be reviewed for evidence of arrhythmia.