Abstracts

Rationale: Complex partial seizures secondary to temporal lobe etiology have been associated with cardiac arrhythmias including sinus tachycardia. Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system associated with postural tachycardia, palpitations, fatigue, diaphoresis, weakness and exercise intolerance. We report a case of POTS syndrome and temporal lobe epilepsy secondary to a cavernoma; the surgical resection of which led to complete resolution of the postural tachycardia.Methods: A 22-year-old female who developed recurrent chest discomfort, nausea, diaphoresis, hot flashes and dizziness on standing that started 15 months after giving birth. Comprehensive cardiac work-up including head-up tilt test diagnosed POTS. She was initiated on Fludrocortisone and Midodrine with minimal response. When she was 28 she developed new episodes of with brief perseveration, blank stare and orofacial movements, at times associated with loss of responsiveness. These were usually preceded by hot flash, nausea and epigastric rising sensation, nausea and epigastric rising sensation.Results: Video EEG showed 2 distinct spells: the first kind was consistent with her POTS symptoms and complex partial seizures with aura. Her Aura was described as nausea, hot flash and epigastric rising sensation . On EEG it showed rhythmic, sharp delta maximal in the left sphenoidal lead, and less prominent in left temporal and subtemporal chains. This was followed by orofacial automatisms, nose wiping and rapid shallow breathing. The EEG showed an evolving left posterior temporal rhythmic activity reaching an alpha frequency that gradually increased in amplitude and followed by decreased in frequency. MRI at this time showed a left temporal cavernoma and given the disabling nature of her spells, she underwent surgery. Her last seizure was 1 month after the surgery and over the 2 year follow up period following the surgery, her orthostatic tachycardia as well as seizures have completely resolved and she is off AEDs for more than 6 months now.Conclusions: Complex partial seizures, POTS and psychogenic nonepileptic phenomena may have overlapping symptoms and semiology. Temporal lobe epilepsy may precipitate arrhythmias which can manifest with orthostatic features or syncope. This is the first case where resolution of POTS was demonstrated following surgery for a temporal cavernoma. This may be a subtle indicator that autonomic dysfunction, manifesting as postural orthostatic tachycardia, can occur secondary to temporal lobe pathology and it may be worth proactively hunting for temporal lobe abnormalities in such patients.