Misdiagnosis of epilepsy: Many seizure-like attacks have a cardiovascular cause

被引:280
作者
Zaidi, A
Clough, P
Cooper, P
Scheepers, B
Fitzpatrick, AP
机构
[1] Manchester Royal Infirm, Manchester Heart Ctr, Manchester M13 9WL, Lancs, England
[2] Hope Hosp, Ctr Clin Neurosci, Salford M6 8HD, Lancs, England
关键词
D O I
10.1016/S0735-1097(00)00700-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES We sought to investigate the value of cardiovascular tests to diagnose convulsive syncope in patients with apparent treatment-resistant epilepsy. BACKGROUND As many as 20%, to 30% of epileptics may have been misdiagnosed. Many of these patients may have cardiovascular syncope, with abnormal movements due to cerebral hypoxia, which may be difficult to differentiate from epilepsy on clinical grounds. METHODS Seventy-four patients (33 men, mean age 38.9 +/- 18 years [range 16 to 77]) who were previously diagnosed with epilepsy were studied. Inclusion criteria included continued attacks despite adequate anticonvulsant drug treatment (n = 36) or uncertainty about the diagnosis of epilepsy, on the basis of the clinical description of the seizures (n = 38). Each patient underwent a head-up tilt test and carotid sinus massage during continuous electrocardiography, electroencephalography and blood pressure monitoring. Ten patients subsequently underwent long-term electrocardiographic (ECG) monitoring with an implantable loop recorder. RESULTS In total, an alternative diagnosis was found in 31 patients (41.9%), including 13 (36.1%) of 36 patients taking an anticonvulsant medication. Nineteen patients (25.7%) developed profound hypotension or bradycardia during the head-up tilt test, confirming the diagnosis of vasovagal syncope. One other patient had a typical vasovagal reaction during intravenous cannulation. Two patients developed psychogenic symptoms during the head-up tilt test. Seven patients (9.5%) had significant ECG pauses during carotid sinus massage. In two patients, episodes of prolonged bradycardia correlated precisely with seizures according to the insertable ECG recorder. CONCLUSIONS A simple, noninvasive cardiovascular evaluation may identify an alternative diagnosis in many patients with apparent epilepsy and should be considered early in the management of patients with convulsive blackouts. (C) 2000 by the American College of Cardiology.
引用
收藏
页码:181 / 184
页数:4
相关论文
共 32 条
[1]   Quality of life of people with epilepsy: A European study [J].
Baker, GA ;
Jacoby, A ;
Buck, D ;
Stalgis, C ;
Monnet, D .
EPILEPSIA, 1997, 38 (03) :353-362
[2]   EPILEPSY [J].
CHADWICK, D .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1994, 57 (03) :264-277
[3]  
DEVINSKY O, 1994, CURRENT DIAGNOSIS NE, P1
[4]  
DIMARCO JP, 1990, ANN INTERN MED, V113, P53, DOI 10.7326/0003-4819-113-1-53
[5]   THE INCIDENCE OF MALIGNANT VASOVAGAL SYNDROME IN PATIENTS WITH RECURRENT SYNCOPE [J].
FITZPATRICK, A ;
THEODORAKIS, G ;
VARDAS, P ;
KENNY, RA ;
TRAVILL, CM ;
INGRAM, A ;
SUTTON, R .
EUROPEAN HEART JOURNAL, 1991, 12 (03) :389-394
[6]  
FITZPATRICK AP, 1991, EUR J CARD PAC ELECT, V1, P25
[7]  
GASTAUT H, 1957, LANCET, V2, P1018
[8]  
GASTAUT H, 1974, EPILEPSIES, P815
[9]   DIAGNOSTIC EFFICACY OF 24-HOUR ELECTROCARDIOGRAPHIC MONITORING FOR SYNCOPE [J].
GIBSON, TC ;
HEITZMAN, MR .
AMERICAN JOURNAL OF CARDIOLOGY, 1984, 53 (08) :1013-1017
[10]   DIFFERENTIATION OF CONVULSIVE SYNCOPE AND EPILEPSY WITH HEAD-UP TILT TESTING [J].
GRUBB, BP ;
GERARD, G ;
ROUSH, K ;
TEMESYARMOS, P ;
ELLIOTT, L ;
HAHN, H ;
SPANN, C .
ANNALS OF INTERNAL MEDICINE, 1991, 115 (11) :871-876