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Clinical Review

First seizures in adults

BMJ 2014; 348 doi: (Published 15 April 2014) Cite this as: BMJ 2014;348:g2470

Rapid Response:

Re: First seizures in adults

The importance of ECG in first seizure assessment.

I would like to thank the authors for this overview of first seizure management. Regarding the cardiological syndromes mentioned I would like to highlight that ECG rather then EEG is mandatory for the identification of potentially fatal arrhythmias and that Brugada syndrome is not classically associated with long QT syndrome but rather ST elevation in leads V1-V3, right bundle branch block and potential sudden death from ventricular fibrillation [1]. Romano Ward syndrome is a form of autosomal dominant congenital long QT syndrome (associated with normal hearing) and Jervell, Lange-Neilsen syndrome is autosomal recessive and is associated with deafness [1]. There are several additional acquired causes of long QT syndrome including drugs such as pimozide, thioridazine, terfenadine, ketoconazole; metabolic disorders such as hypokalaemia, hypomagnesaemia; and neurosurgical disorders such as subarachnoid haemorrhage [1].

When an ECG or rhythm strip is recorded during EEG monitoring, this should also be reviewed for evidence of arrhythmia.


Ramrakha P, Moore K. Oxford Handbook of Acute Medicine 2nd Edition. Oxford University Press 2005 p72-74

Competing interests: No competing interests

22 April 2014
John J McKinley
DAMC Fellow in Movement Disorders
Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin
57 Eccles Street Dublin 7