Syncope or epileptic fits? Some examples of diagnostic confounding factors

Kowacs, Pedro André; Júnior, Erasmo Barros da Silva; Santos, Heraldo L.; Rocha, Samanta Fabricio Blattes da; Simão, Cristiane; Meneses, Murilo S.; Arruda, Walter Oleschko

doi:10.1590/s0004-282x2005000400008

Cited by 5 publications

(4 citation statements)

References 22 publications

(5 reference statements)

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“…First of all, the duration of both episodes lasted around 2–3 min. Regarding seizures, generalized tonic-clonic seizure lasts 30 s‒5 min, and secondarily, generalized tonic-clonic seizure lasts 62 s (16 s–108 s), whereas syncope has fewer duration, around ∼15 s (3 s–30 s) [ 15 ]. In epileptic seizures, falls are characterized as fast and tonic, in contrast to syncope where falls are slow and flacid [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding seizures, generalized tonic-clonic seizure lasts 30 s‒5 min, and secondarily, generalized tonic-clonic seizure lasts 62 s (16 s–108 s), whereas syncope has fewer duration, around ∼15 s (3 s–30 s) [ 15 ]. In epileptic seizures, falls are characterized as fast and tonic, in contrast to syncope where falls are slow and flacid [ 15 ]. The patient experienced tongue-biting, a symptom that is presented rarely in syncope, while is a common symptom in epileptic seizure [ 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

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TMS-Induced Seizure during FDA-Approved Bilateral DMPFC Protocol for Treating OCD: A Case Report

Mikellides

Michael²,

Schuhmann

et al. 2021

Case Rep Neurol

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Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation therapy that has become a method of choice for the treatment of several neuropsychiatric disorders such as depression and OCD. It is considered to be a safe and well-tolerated treatment, with only few side effects. The most serious adverse event during any rTMS treatment is the potential induction of a seizure. rTMS has shown very encouraging results for treatment-resistant OCD, although the optimal target area and the stimulation frequency are still matters of controversy. Here, we present a 19-year-old female patient with OCD who experienced seizure during the 7th session of her rTMS treatment using the FDA-approved 20-Hz protocol for OCD applied bilaterally over the left and right DMPFC using a double-cone coil. Nonetheless, it still unknown whether the seizure occurred as a consequence of rTMS, as the patient was also in a specific seizure risk group. Future reviews are needed to further clarify the mechanisms that may trigger seizures during rTMS treatments in order to reduce the likelihood of rTMS-induced seizures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

TMS-Induced Seizure during FDA-Approved Bilateral DMPFC Protocol for Treating OCD: A Case Report

Mikellides

Michael²,

Schuhmann

et al. 2021

Case Rep Neurol

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“…21 There is considerable clinical overlap between syncope and epileptic seizures, so only a few of the symptoms and signs evaluated in this study helped to distinguish between the two conditions. Kim et al, 21 Saengpattrachai, 23 and Kowacs et al 24 all attempted to distinguish between vasovagal syncope and epileptic seizures based on clinical manifestations, but the significant clinical symptoms and signs were not completely consistent among the studies. Aura, eyeball deviation, headache, and blurred vision were identified as significant symptoms or signs in one or more of these studies, but not in the present study.…”

Section: Discussionmentioning

confidence: 99%

Children with transient loss of consciousness: Clinical characteristics and the effectiveness of diagnostic tests

Choi

Han

Lee

2020

Pediatrics & Neonatology

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Background: Transient loss of consciousness (TLOC) is common among children and adolescents. The aims of this study were to identify clinical differences between patients with vasovagal syncope and those with epileptic seizures, which account for a large proportion of TLOC cases, and to evaluate the effectiveness of various diagnostic tests. Methods: The medical records of 160 children and adolescents with TLOC were analyzed retrospectively, and age, sex, clinical symptoms, and trigger factors were recorded. The cardiological and neurological evaluations performed included electrocardiograms, computed tomography scanning, magnetic resonance imaging, electroencephalograms (EEGs), echocardiograms, and head-up tilt tests (HUTTs). Overall assessments of the 160 patients generated final diagnoses. Results: The mean age of patients was 14.6 years old and TLOC occurred more frequently among girls (59.4%). The most common final diagnosis was vasovagal syncope (n Z 102, 63.4%), followed by undetermined (n Z 21, 13.1%) and epileptic seizures (n Z 17, 10.6%). There were many other diagnoses, including cardiogenic syncope (1.3%). Patients diagnosed with vasovagal syncope were much more likely to have dizziness or light-headedness and blurred vision as pre-symptoms (p < 0.05), whereas patients diagnosed with epileptic seizures were more likely to have convulsions as an accompanying sign (p < 0.05). In addition, standing up was the most significant trigger factor for TLOC among those diagnosed with vasovagal syncope (p < 0.05). The sensitivity, specificity, and accuracy of the HUTT for vasovagal syncope were 95.1%, 75.0%, and 91.8%, respectively. Similarly, the sensitivity, specificity, and accuracy of EEGs for epileptic seizures were 80.0%, 70.6%, and 80.0%, respectively. Conclusion: Vasovagal syncope and epileptic seizures should be considered as possible causes of most cases of TLOC in children and adolescents. An accurate case history and appropriate evaluation are essential for correct diagnoses.

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“…Indeed, EEG is widely recognised as contributing to the misdiagnosis of epilepsy (Kowacs et al 2005). Not only does this technique have intrinsic limitations (subjective evaluation of reports and relative value of specificity/sensitivity), but EEG abnormalities (including specific patterns) are not uncommon in syncope patients (Abubakr and Wambacq 2005).…”

Section: Discussionmentioning

confidence: 99%

Over‐interpretation of electroclinical and neuroimaging findings in syncopes misdiagnosed as epileptic seizures

Fattouch

Bonaventura²,

Strano³

et al. 2007

Epileptic Disorders

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Syncope and epileptic seizures share some common clinical characteristics that may complicate the diagnostic process. In clinical practice, syncope is frequently misdiagnosed as an epileptic seizure and consequently treated with antiepileptic drugs. In this study, we identified 57 patients with syncope (diagnosis based on accepted criteria) who had come to our unit with a previous diagnosis of definite epilepsy in 30 cases (syncope misdiagnosed as epileptic seizures, SMS), or suspected epilepsy in the remaining 27 cases (unrecognized syncope, US). We attempted to identify factors underlying misdiagnosis by reviewing clinical findings, particularly potentially confounding features, and EEG/neuroimaging data. Finally, we compared these two groups of patients to search for crucial elements that had led to misdiagnosis. Although some clinical elements were found to be confounding in both groups, it was the interpretation of the EEG and MRI findings, particularly when combined with the confounding clinical features that constituted the main reasons for misdiagnosis.

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Syncope or epileptic fits? Some examples of diagnostic confounding factors

Cited by 5 publications

References 22 publications

TMS-Induced Seizure during FDA-Approved Bilateral DMPFC Protocol for Treating OCD: A Case Report

TMS-Induced Seizure during FDA-Approved Bilateral DMPFC Protocol for Treating OCD: A Case Report

Children with transient loss of consciousness: Clinical characteristics and the effectiveness of diagnostic tests

Over‐interpretation of electroclinical and neuroimaging findings in syncopes misdiagnosed as epileptic seizures

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