Naci CEVİZ, Mehmet KARACAN, Haşim OLGUN, Duygu BİDEV, Hüseyin TAN

İdiyopatik epilepsi tanısı ile izlenen hastalarda epilepsi ile karışan kardiak veya vazovagal senkop sıklığı

Giriş: Epilepsi tanısı; geçici şuur kaybının klinik bulguları, aile öyküsü ve elektroensefalografi bulguları birleştirilerek konulur. Epilepsi tanısı ile izlenen hastalardaki yanlış tanı oranının %5-31,8 arasında değiştiği bilinmektedir. Epilepsi yanlış tanısı konulmasının nedenleri, hikâyenin eksik ve dikkatsiz alınması, ailede epilepsi öyküsü olması, özgeçmişinde febril konvülziyon öyküsünün olması, elektroensefalografik patolojik bulguların varlığının klinik bulguların önüne geçmesi olarak sıralanabilir. Epilepsinin en fazla karıştığı klinik tanı vazovagal senkoptur. Ayrıca kardiyak nedenlerle meydana gelen senkoplar da yanlışlıkla epilepsi tanısı alabilmektedir.Gereç ve Yöntem: Çalışmaya daha önce epilepsi tanısı alan 119 çocuk dahil edildi. Hastaların %62,1’i (74/119) erkekti ve yaş ortalaması 9,35 yıl idi. Tüm hastaların nöbet özellikleri ve aile öyküleri yeniden sorgulandı ve muayeneleri yapıldı. Tüm hastalara elektrokardiyografik değerlendirme ve 109 hastaya ekokardiyografik çalışma yapıldı. İhtiyaç duyulduğunda head-up tilt testi, 24 saatlik Holter elektrokardiyografi incelemesi ve efor testi yapıldı. Bulgular: Geçici şuur kaybına neden olabilecek yapısal kardiyak problem veya aritmi hiçbir hastada saptanmadı. Toplam 3 hastada vazovagal senkop saptandı (%2,5). Bu hastalar yanlış olarak epilepsi tanısıyla takip edilmekteydiler. Sonuç: Vazovagal senkoplu bazı hastalar yanlışlıkla epilepsi olarak takip edilebilirler. Hikâye alınırken gösterilecek daha fazla dikkat, elektroensefalografi ve tilt testi sonuçlarının klinik bulgular göz önüne alınarak daha dikkatlice değerlendirilmesi, yanlış tanı oranlarını azaltabilir.

Cardiac or vasovagal syncope misdiagnosed as idiopathic epilepsy

Introduction: Epilepsy is diagnosed by combining the clinical features of the temporary loss of consciousness, family history and electroencephalography. False diagnosis rate among patients with epilepsy is reported between 5% and 31.5%. Possible reasons of false diagnosis are; carelessly taken history, presence of family members with epilepsy, presence of previous febrile convulsions, and to give preference to the pathologic electroencephalographic findings. The most common problem that is misdiagnosed as epilepsy is vasovagal syncope. In addition cardiac reasons can be misdiagnosed as epilepsy. In the present study, we aimed to evaluate the frequency of vasovagal and cardiovascular syncope among children with a diagnosis of idiopathic epilepsy. Materials and Method: A total of 119 children with a previous diagnosis of epilepsi were included in the study. The 62.1% (74/119) of the patients were male, and the mean age was 9.35 years. All patients were reevaluated in terms of the features of their seizures and the family history. Then they were examined. A standard electrocardiography was obtained in all and echocardiography in 109 patients. Head-up tilt table test, 24-hour electrocardiography and treadmill tests were performed when needed. Results: No constitutional cardiac problem or arrhythmia was detected as a cause of temporary loss of consciousness. Vasovagal syncope was diagnosed in 3 patients (2.5%). They were being followed with a false epilepsy diagnosis. Conclusions: Some patients with vasovagal syncope can be misdiagnosed as epilepsy. More attention to history taking and to evaluation of the results of electroencephalography and tilt test results may lower the false diagnosis rate.

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