When a seizure is not a real seizure!

Soheila Talebi; Farzaneh Ghobadi; Sameer Chaudhari; Ely Gracia; Ola Olatunde; Gerald Pekler; Ferdinand Visco; Getaw Worku Hassen

doi:10.1016/j.ajem.2015.07.077

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When a seizure is not a real seizure!

Soheila Talebi, MD

New York Medical College, Metropolitan Hospital, Medicine Department, New York, NY

Farzaneh Ghobadi, MD

New York Medical College, Metropolitan Hospital, Emergency Department, New York, NY

Sameer Chaudhari, MD

Newark Beth Israel Medical Center, Cardiology Department, New York, NY

Ely Gracia, MD

Ola Olatunde, MD

New York Medical College, Metropolitan Hospital, Medicine Department, New York, NY

Gerald Pekler, MD

Ferdinand Visco, MD

New York Medical College, Metropolitan Hospital, Cardiology Department, New York, NY

Getaw Worku Hassen, MD, PHD

New York Medical College, Metropolitan Hospital, Emergency Department, New York, NY

DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.077

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Fig. 1

A, Baseline ECG: Normal sinus rhythm, Normal QTC interval: 396 milliseconds.

B, ECG upon admission: Normal sinus rhythm with Generalized ST, T, changes with prolonged QTc: 521 milliseconds.

C, ECG upon admission: normal sinus rhythm, Bigeminy premature ventricular complex (R on T wave).

Fig. 2

A, ECG upon admission: Normal sinus rhythm with wide complex QRS and prolonged QTc: 474 milliseconds.

B, Paroxysmal Supraventricular Tachycardia (PSVT).

C, ECG after control PSVT: Normal sinus rhythm with prolonged QTc: 568 milliseconds.

We report here 2 cases of methadone induced Torsades de Pointes with a clinical presentation mimicking convulsive seizures in a substance abuser These cases highlight the importance of being aware of methadone-induced Torsades de Pointes and the occasional atypical clinical presentations of this condition.

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When a seizure is not a real seizure!

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