Journal of Pediatric Epilepsy 2020; 09(01): 018-021
DOI: 10.1055/s-0040-1701240
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Ictal Bradyarrhythmia in a 2-Year-Old Male with Brainstem Embryonal Tumor

1  Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
2  Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
1  Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
2  Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
1  Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
2  Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
› Author Affiliations
Further Information

Publication History

01 November 2019

24 December 2019

Publication Date:
24 January 2020 (online)

Abstract

Ictal bradyarrhythmia can be challenging to diagnose when motor features of seizures are absent. Associated bradycardia can involve periods of asystole requiring cardiac pacemaker placement. Here, we report a 2-year-old male with a brainstem embryonal tumor with more than 30 seizures per day manifesting as bradycardia, loss of tone, and decreased responsiveness, followed by vomiting. Associated electrographic changes were localized to the right temporal head region, where the patient's tumor exerted mass effect. The patient was treated with lacosamide at higher doses than previously reported (24 mg/kg/d) and became seizure-free on a combination of this medication with clobazam. Oral albuterol was also used to augment his heart rate as the patient was not a candidate for cardiac pacemaker insertion.