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Case Reports
. 2017 Feb 21:7:49-53.
doi: 10.1016/j.ebcr.2017.02.001. eCollection 2017.

Epileptic Angina

Sachin Sureshbabu  1 , Dinesh Nayak  2 , Sudhir Peter  3 , Chindripu Sobhana  3 , Gaurav Mittal  1
Affiliations
Case Reports

Epileptic Angina

Sachin Sureshbabu et al. Epilepsy Behav Case Rep. .

Abstract

Purpose: To investigate the probable ictal origin of unexplained episodic chest pain and if possible to lateralize and localize the epileptic focus.

Methods: A 14 year old boy presented with episodic short lasting localized chest pain. His cardiac and other systemic work-up were normal. MRI brain did not reveal any structural pathology. Video telemetry was done for characterization of the paroxysms.

Results: Interictal record showed left fronto-central epileptiform discharges. A left hemispheric, predominantly centroparietal ictal rhythm was identified. The possible localizations of this unusual semiology are somatosensory areas I and II, supplementary sensorimotor area, posterior insula and cingulate cortex. Patient responded remarkably to antiseizure drugs.

Conclusion: Pain is a rare manifestation of epilepsy observed in less than 1% of patients. When present, it is usually accompanied by other focal features. This rare occurrence of epileptic seizures masquerading as angina is a novel observation.

Keywords: Ictal pain; Insula; Parietal; Somatosensory aura.

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Figures

Fig. 1
Fig. 1
Interictal EEG record: Common average referential montage at normal and slower paper speed (upper panel) shows left hemispheric poly spike and wave discharges along with the right hemisphere showing positivity at the onset; the bipolar montage (lower panel) shows more prominent anterior distribution especially frontocentral.
Fig. 2
Fig. 2
Ictal EEG record showed a 4-5 Hz parasaggital rhythm; while a faster 9-10 Hz activity was seen in mid and posterior temporal region in the left hemisphere.
See this image and copyright information in PMC

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