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All seizures are not epilepsy: many have a cardiovascular cause
1Division of Pediatric Cardiology, Shifa International Hospital, Islamabad.
Insights
Cardiovascular tests can identify alternative diagnoses in children with apparent epilepsy, revealing that many misdiagnosed cases are actually vasovagal syncope or other cardiac conditions.
Area of Science:
- Pediatric Neurology
- Cardiology
- Diagnostic Medicine
Background:
- Adult studies suggest up to 35% of epilepsy diagnoses may be misdiagnosed.
- Cardiovascular syncope can mimic epilepsy due to abnormal movements from cerebral hypoxia.
- Research on differentiating syncope from epilepsy in children is limited.
Purpose of the Study:
- To evaluate the diagnostic utility of cardiovascular tests for convulsive syncope in children with suspected treatment-resistant epilepsy.
- To determine the prevalence of misdiagnosed epilepsy in pediatric patients presenting with convulsive episodes.
Main Methods:
- Study included 31 children (mean age 10.07 years) with prior epilepsy diagnoses.
- Patients underwent 12-lead electrocardiogram (ECG), orthostatic testing, and carotid sinus massage with continuous monitoring.
- Holter monitoring was performed in 10 patients.
Main Results:
- An alternative diagnosis was identified in 61.3% of children.
- Vasovagal syncope was diagnosed in 29% based on orthostatic test findings.
- Long QT syndrome (LQTS) was identified in 22.5% of patients.
Conclusions:
- Non-invasive cardiovascular assessments can reveal alternative diagnoses in children with apparent epilepsy.
- Early consideration of cardiovascular evaluation is recommended for children experiencing convulsive episodes.
Objectives:
The aim of this study was to investigate the value of cardiovascular tests to diagnose convulsive syncope in children with apparent treatment-resistant epilepsy and to assess the extent of misdiagnosis of epilepsy in children.
Background:
Adult studies have shown that up to 35% of epileptics may have been misdiagnosed. These patients may have cardiovascular syncope, with abnormal movements due to cerebral hypoxia, which may be difficult to differentiate from epilepsy. Studies in children are lacking.
Methods:
Thirty-one children (12 male, mean age 10.07 +/- 5 years [range 4 to 17]) who were previously diagnosed with epilepsy were studied. Inclusion criteria were continued attacks despite adequate anticonvulsant drug treatment (n = 17) or possible epilepsy on the basis of clinical grounds (n = 14). Each patient underwent a 12-lead electrocardiogram (ECG), an orthostatic test and carotid sinus massage during continuous ECG and blood pressure monitoring. Ten patients had Holter monitoring.
Results:
An alternative diagnosis was found in 19 patients (61.3%), including 8 (47%) of 17 patients taking anticonvulsant medications. Nine patients (29%) developed profound hypotension or bradycardia during orthostatic test, confirming the diagnosis of vasovagal syncope. Seven patients (22.5%) had long Q-T syndrome (LQTS). Two (6.4%) had significant ECG pauses during carotid sinus massage. In these two patients episodes of prolonged bradycardia correlated precisely with seizures by Holter recording, was noted. One patient (3.2%) developed psychogenic symptoms during the orthostatic test.
Conclusion:
A simple, non-invasive cardiovascular evaluation may identify an alternative diagnosis in many children with apparent epilepsy and should be considered early in the management of children with convulsive episodes.