Epilepsy or syncope? An analysis of 55 consecutive patients with loss of consciousness, convulsions, falls, and no EEG abnormalities.
Pacing Clin Electrophysiol
; 33(7): 804-13, 2010 Jul.
Article
em En
| MEDLINE
| ID: mdl-20158619
ABSTRACT
BACKGROUND:
Patients with loss of consciousness and convulsion often have the diagnosis of epilepsy despite normal electroencephalograms (EEGs).OBJECTIVE:
To evaluate the proportion of patients referred to neurologists with presumed epilepsy and normal EEGs who have an alternative cause of syncope.METHODS:
It was a cross-sectional study of 55 consecutive patients aged 6-85 (41 +/- 24) years presenting with faints, falls, convulsions, and normal EEGs, who were referred to neurologists before going to cardiologists. All patients underwent clinical examination, electrocardiogram, and echocardiogram. Head-up tilt table testing (HUT), 24-hour-Holter, and carotid sinus massage was offered as needed. Electrophysiological studies were undertaken in patients with structural heart disease or severe palpitations.RESULTS:
Anticonvulsant agents had been prescribed to 35 patients (64%) before entering the study. Vasovagal syncope was found in 22 (40%) patients, life-threatening arrhythmias in seven (13%), carotid sinus hypersensitivity in six (11%), orthostatic hypotension in three (5%), and aortic stenosis in one (2%). Etiology of syncope could not be found in 16 (29%) patients. Arrhythmias comprised two complete atrioventricular blocks, one sustained monomorphic ventricular tachycardia, one ventricular fibrillation, one atrial tachycardia, and two atrioventricular node reentrant tachycardias. Two patients developed a prolonged asystole during HUT. Presumptive diagnosis of syncope was found in 39 patients (71%). Patients on or off anticonvulsant drugs had 64% and 84% diagnosis of syncope, respectively (odds ratio = 0.33; 95% confidence interval 0.08-1.36; P = 0.13).CONCLUSIONS:
Life-threatening arrhythmias and syncope can be present in patients with presumed epilepsy and normal EEG. Prescription of anticonvulsant agents in these patients should wait for a cardiovascular assessment.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Arritmias Cardíacas
/
Convulsões
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Síncope
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Inconsciência
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Erros de Diagnóstico
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Eletrocardiografia
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Epilepsia
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Observational_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Child
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2010
Tipo de documento:
Article