Fehldiagnose Epilepsie beim Long-QT-Syndrom: Sollte bei jedem Anfall ein EKG abgeleitet werden?

Abstract

Syncope is a common and difficult differential diagnosis for epilepsy. One possible cause for a cardiac syncope is a long QT syndrome (LQTS). LQTS with torsade de pointes tachycardia can lead to lethal ventricular fibrillation and cardiac arrest. Patients with LQTS when first diagnosed as suffering from epileptic fits often experience a particularly long diagnostic delay which may even take years. In some cases, the diagnosis of LQTS is not made until the patient needs resuscitation due to a cardiac arrest. Therefore, ECG recording should be performed for every patient presenting with a seizure considered to be of epileptic origin not only at the beginning of the disease but also when fits occur in spite of antiepileptic treatment in order to prevent an incorrect diagnosis and delay in making the correct diagnosis.

<p>A case of near-sudden unexpected death in epilepsy due to ventricular fibrillation</p>

“…Convulsive syncope caused by cardiac arrhythmias is likely to be misdiagnosed as epilepsy because they share several clinical features 18. In the present patient, EEG and video-EEG monitoring were performed after several previous episodes of seizures, but the epilepsy was diagnosed based on the patient guardian’s statement and treated because definite inter-ictal epileptiform discharge was absent.…”

“…Therefore, EEG was not useful in the differential diagnosis of epilepsy and convulsive syncope in this case since the patient had only rare seizure events. Further examinations such as exercise treadmill testing, provocative drug ECG testing, genetic testing, and electrophysiological studies can be considered for differentiating between epileptic seizure and convulsive syncope 18,19. In this case report, the patient had a brief post-ictal period at one day before the admission; thus, convulsive syncope can be considered.…”