PMC7170332_01
AF after the initial GTCS episode. The above EKG demonstrates the AF observed within 30 min, after the initial GTCS episode (August 2017). The heart rate during this period was 116 BPM.
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Hospitalization during the post-ictal phase recorded AF with a rapid ventricular response (RVR) as recorded in the ECG (Fig. 1).
EEG during EMU admission (Feb 2019). The EEG of the patient, (A) at the beginning of the seizure episode (the top arrow shows left temporal moderate rhythmic theta activity), and (B) at the end of the seizure (one-minute duration). The heart rate (green), was consistent during episode. The patient did not progress to a GTCS. The two images are at sensitivity 10.
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A follow-up epilepsy monitoring unit (EMU) recording to determine seizure localization prompting anti-seizure medication discontinuation, captured one focal seizure with left temporal onset and psychomotor arrest but no changes in the cardiac rate or rhythm (Fig. 2). As per EMU protocol, he was immediately treated with lorazepam to avoid secondary generalization and to prevent sudden unexpected death in epilepsy (SUDEP). At this time the patient realized the importance of medication compliance and his epilepsy is currently well controlled with two ASDs.