Analysis of misdiagnosed cases: epilepsy and syncope_Journal of Epilepsy

Authors：

 XUYan ¹ ,  YANGNa ^2,3 , QUXuefeng ³ , RENXian ³ , LIUJingyi ⁴ , LIXuebin ⁵ , GUOJihong ⁵ , GAOXuguang ¹ ,  LIUXianzeng ³

1. Department of Neurology, Peking University People′s Hospital;
2. Division of Epilepsy Center & Neurofunctional Monitoring Laboratory;
3. Department of Neurology, Kailuan General Hospital, Tangshan;
4. Beijing Friendship Hospital, Capital Medical University;
5. Department of Cardiology, Peking University People′s Hospital;

Corresponding author：

LIUXianzeng, Email: liuxianzeng2004@sina.com

Keywords：

Epilepsy; Syncope; Arrhythmia; Loss of consciousness; EEG/ECG monitoring

DOI：

10.7507/2096-0247.20160023

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore how to differentiate the epilepsy and syncope in order to minimize the misdiagnosis. Methods Retrospectively analyzed the medical record of 6 cases which were misdiagnosed as epilepsy or syncope during April 2008 to September 2012 and reviewed the literatures about the differential diagnosis. Results Among the clinical characteristics, the ictal positional tone and loss of consciousness as well as the duration of postictal confusion are very important to the differential diagnosis. The ictal EEG shows highly rhythmic abnormal discharges when epileptic seizures occur. However, the ictal EEG would become slower and flatler during syncope. Conclusions When the automomic disorder and signs such as chest distress, arrhythmia. appear, the causes should not be limited in the cardiac diseases, the functional or structural abnormalities of the nervous system innervating the heart should also be considered; on the contrary, convulsions might not only due to the abnormal electrical activity in the brain, but syncope.

Citation： XUYan, YANGNa, QUXuefeng, RENXian, LIUJingyi, LIXuebin, GUOJihong, GAOXuguang, LIUXianzeng. Analysis of misdiagnosed cases: epilepsy and syncope. Journal of Epilepsy, 2016, 2(2): 123-127. doi: 10.7507/2096-0247.20160023 Copy

1.	Josephson CB, Rahey S, Sadler RM. Neurocardiogenic syncope: frequency and consequences of its misdiagnosis as epilepsy. CanJNeurol Sci , 2007, 34(2) : 221-224.
2.	Smith D, Defalla BA, Chadwick DW. The misdiagnosis of epilepsy and the management of refractory epilepsy inaspecialist clinic. QJM ,1999, 92(1): 15-23.
3.	Chowdhury FA, Nashef L, Elwes RD. Misdiagnosis in epilepsy:areview and recognition of diagnostic uncertainty. EurJNeurol, 2008 ,15(10) : 1034-1042.
4.	杨倩,王芳. 恩施地区儿童癫痫诊治及管理存在的问题(附225例分析). 临床误诊误治 , 2015 , 28(4): 30-33.
5.	Leutmezer F, Schernthaner C, Lurger S, et al. Electrocardiographic changes at the onset of epileptic seizures. Epilepsia , 2003 , 44(3): 348-354.
6.	Blumhardt LD, Smith PE, Owen L. Electrocardiographic accompaniments of temporal lobe epileptic seizures. Lancet, 1986, 1(8489): 1051-1056.
7.	Schernthaner C, Lindinger G, Potzelberger K, et al. Autonomic epilepsy - the influence of epileptic discharges on heart rate and rhythm. Wien Klin Wochenschr ,1999, 111(10): 392-401.
8.	Ficker DM, So EL, Annegers J, et al. Population-based study of the incidence of sudden unexplained death in epilepsy. Neurology, 1998, 51(5): 1270-1274.
9.	Zijlmans M, Flanagan F, Gotman J. Heart rate changes and ECG abnormalities during epileptic seizures: prevalence and definition of an objective clinical sign. Epilepsia, 2002, 43(8): 847-854.
10.	Nei M, Ho RT, Abou-Khalil BW, et al. EEG and ECG in sudden unexplained death in epilepsy .Epilepsia, 2004, 45(4): 338-345.
11.	Oppenheimer SM, Gelb A, Girvin JP, et al. Cardiovascular effects of human insular cortex stimulation .Neurology,1992, 42(9): 1727-1732.
12.	Aline P, Pansani, Diego B, et al. Repeated amygdala-kindled seizures induce ictal rebound tachycardia in rats. Epilepsy & Behavior, 2011, 22(3): 442-449.
13.	Aminoff MJ, Scheinman MM, Griffin JC, et al. Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias. Ann Intern Med, 1988, 108(6): 791-796.
14.	Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J, 2009, 30(21): 2631-2671.
15.	Lempert T, Bauer M, Schmidt D. Syncope:avideometric analysis of 56 episodes of transient cerebral hypoxia . Ann Neurol ,1994 , 36(2) : 233-237.
16.	Duplyakov D, Golovina G, Garkina S. Is it possible to accurately differentiate neurocardiogenic syncope from epilepsy?. Cardiology Journal, 2010, 17(4): 420-427.
17.	Olshansky B. Syncope: overview and approach to management. In:Grubb BP, Olshansky BP (eds): Syncope-Mechanisms and Management. Malden, MA, Blackwell Futura, 2005: 1-46.
18.	Sheldon R. How to differentiate syncope from seizure. Cardiol Clin, 2015, 33(3): 377-385.
19.	Yilmaz S, Gökben S, Levent E, et al. Syncope or seizure? The diagnostic value of synchronous tilt testing and video-EEG monitoring in children with transient loss of consciousness. Epilepsy Behav, 2012, 24(1): 93-96.

1. Josephson CB, Rahey S, Sadler RM. Neurocardiogenic syncope: frequency and consequences of its misdiagnosis as epilepsy. CanJNeurol Sci , 2007, 34(2) : 221-224.
2. Smith D, Defalla BA, Chadwick DW. The misdiagnosis of epilepsy and the management of refractory epilepsy inaspecialist clinic. QJM ,1999, 92(1): 15-23.
3. Chowdhury FA, Nashef L, Elwes RD. Misdiagnosis in epilepsy:areview and recognition of diagnostic uncertainty. EurJNeurol, 2008 ,15(10) : 1034-1042.
4. 杨倩,王芳. 恩施地区儿童癫痫诊治及管理存在的问题(附225例分析). 临床误诊误治 , 2015 , 28(4): 30-33.
5. Leutmezer F, Schernthaner C, Lurger S, et al. Electrocardiographic changes at the onset of epileptic seizures. Epilepsia , 2003 , 44(3): 348-354.
6. Blumhardt LD, Smith PE, Owen L. Electrocardiographic accompaniments of temporal lobe epileptic seizures. Lancet, 1986, 1(8489): 1051-1056.
7. Schernthaner C, Lindinger G, Potzelberger K, et al. Autonomic epilepsy - the influence of epileptic discharges on heart rate and rhythm. Wien Klin Wochenschr ,1999, 111(10): 392-401.
8. Ficker DM, So EL, Annegers J, et al. Population-based study of the incidence of sudden unexplained death in epilepsy. Neurology, 1998, 51(5): 1270-1274.
9. Zijlmans M, Flanagan F, Gotman J. Heart rate changes and ECG abnormalities during epileptic seizures: prevalence and definition of an objective clinical sign. Epilepsia, 2002, 43(8): 847-854.
10. Nei M, Ho RT, Abou-Khalil BW, et al. EEG and ECG in sudden unexplained death in epilepsy .Epilepsia, 2004, 45(4): 338-345.
11. Oppenheimer SM, Gelb A, Girvin JP, et al. Cardiovascular effects of human insular cortex stimulation .Neurology,1992, 42(9): 1727-1732.
12. Aline P, Pansani, Diego B, et al. Repeated amygdala-kindled seizures induce ictal rebound tachycardia in rats. Epilepsy & Behavior, 2011, 22(3): 442-449.
13. Aminoff MJ, Scheinman MM, Griffin JC, et al. Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias. Ann Intern Med, 1988, 108(6): 791-796.
14. Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J, 2009, 30(21): 2631-2671.
15. Lempert T, Bauer M, Schmidt D. Syncope:avideometric analysis of 56 episodes of transient cerebral hypoxia . Ann Neurol ,1994 , 36(2) : 233-237.
16. Duplyakov D, Golovina G, Garkina S. Is it possible to accurately differentiate neurocardiogenic syncope from epilepsy?. Cardiology Journal, 2010, 17(4): 420-427.
17. Olshansky B. Syncope: overview and approach to management. In:Grubb BP, Olshansky BP (eds): Syncope-Mechanisms and Management. Malden, MA, Blackwell Futura, 2005: 1-46.
18. Sheldon R. How to differentiate syncope from seizure. Cardiol Clin, 2015, 33(3): 377-385.
19. Yilmaz S, Gökben S, Levent E, et al. Syncope or seizure? The diagnostic value of synchronous tilt testing and video-EEG monitoring in children with transient loss of consciousness. Epilepsy Behav, 2012, 24(1): 93-96.

Previous Article
Efficacy and aging comparative study of different doses and sources of lamotrigine on cortex convulsive threshold in electrical stimulated rats
Next Article
癫痫共患偏头痛的研究进展

Journal of Epilepsy

Analysis of misdiagnosed cases: epilepsy and syncope

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content