Epileptic Angina

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 rhythmwas 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 raremanifestation of epilepsy observed in less than 1% of patients. When present, it is usually accompanied by other focal features. This rare occurrence of epileptic seizuresmasquerading as angina is a novel observation. (C) 2017 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license