Long QT Syndrome Masquerading as Refractory Epilepsy in an Adolescent

Abstract

Introduction: Epileptic seizures can be difficult to distinguish from other etiologies causing cerebral hypoxia, especially cardiac diseases. Long QT syndrome (LQTS) frequently masquerades as seizures due to transient cerebral hypoxia caused by decreased cardiac output secondary to ventricular arrhythmias. Early and accurate diagnosis of LQTS is crucial to prevent inappropriate treatment with anti-epileptic drugs (AEDs) and sudden death. Case Summary: We report a rare case of Jervell and Lange-Nielsen syndrome in a 13-year-old adolescent misdiagnosed with refractory epilepsy and treated with various AEDs for nearly 10 years. The patient experienced seizure-like episodes accompanied by palpitations, typically triggered by excitement, fright, or stress. The presence of bilateral sensorineural deafness and refractoriness to multiple AEDs raised suspicion for LQTS, which was confirmed by characteristic ECG findings. The patient was treated with a beta-blocker, and over a one-year follow-up, no new episodes of syncope or seizures occurred. Conclusion: This case underscores the importance of ECG in the evaluation of seizures and highlights how LQTS can mimic seizure disorders. Treatment of long QT syndrome prevents seizure like episodes and risk of sudden death.