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Syncope and seizures are often indistinguishable clinically.We present a series of 12 patients diagnosed as having epilepsy.Despite normal or nonspecific electroencephalographic findings,11 of 12 patients were treated or offered treatment with long-term anticonvulsant agents. Subsequently,diagnoses of arrhythmic or neurally mediated syncope were made in all patients using Holter monitoring,long-term ambulatory loop electrocardiographic recording,or tilt-table studies.Arrhythmias included torsales de pointes(four patients),atrioventricular nodal reentrant supraventricular tachycardia(one patient),and sinus arrest(two patients). The remaining five patients had neurally mediated syncope with hypotension and bradycardia,including asystole in two patients.Treatment for the documented cardiovascular abnormalities resulted in the alleviation of syncopal symptoms.Because the observed cardiovascular abnormalities are potentially fatal,this series suggests that undiagnosed cardiac syncope may contribute to the documented increased sudden death rate in patients with presumed epilepsy.Cardiac causes of loss of consciousness should be considered in patients with presumed epilepsy,atypical premonitory symptoms(such as nausea,lightheadedness,or palpitations),nondiagnostic electroencephalograms,and failure to respond to anticonvulsant therapy. |
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arrhythmia,cardiac
asystole
cardiovascular disease
convulsive syncope
electrocardiogram,abnormal
electrocardiogram,loop
heart block
heart block,complete
Holter monitoring
misdiagnosis
pacemaker,cardiac-transvenous
Romano-Ward syndrome
seizure
seizure,cardiac arrhythmia causing
seizure,complications following
seizure,differential diagnosis of
seizure,medication failure
sudden death
syncope
syncope,differential diagnosis of
torsades de points
treatment of neurologic disorder
unconsciousness
upright-tilt test
vasovagal episode
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