Someone told me to research vaso-vagal issues. I'm just digging holes and finding things of course that make me think, "wow, sounds like me in the grocery store the other day - or that happened while I was sitting here."
Medline ®
Abstract for Reference
6
of 'Nonepileptic paroxysmal disorders in adolescents and adults'
|
| 6 | |
| TI | Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause. |
| AU | Zaidi A; Clough P; Cooper P; Scheepers B; Fitzpatrick AP |
| SO | J Am Coll Cardiol 2000 Jul;36(1):181-4. |
| |
| | OBJECTIVES: We sought to investigate the value of cardiovascular tests
to diagnose convulsive syncope in patients with apparent
treatment-resistant epilepsy. BACKGROUND: As many as 20% to 30% of
epileptics may have been misdiagnosed. Many of these patients may have
cardiovascular syncope, with abnormal movements due to cerebral
hypoxia, which may be difficult to differentiate from epilepsy on
clinical grounds. METHODS: Seventy-four patients (33 men, mean age 38.9
+/- 18 years [range 16 to 77]) who were previously diagnosed with
epilepsy were studied. Inclusion criteria included continued attacks
despite adequate anticonvulsant drug treatment (n = 36) or uncertainty
about the diagnosis of epilepsy, on the basis of the clinical
description of the seizures (n = 38). Each patient underwent a head-up
tilt test and carotid sinus massage during continuous
electrocardiography, electroencephalography and blood pressure
monitoring. Ten patients subsequently underwent long-term
electrocardiographic (ECG) monitoring with an implantable loop
recorder. RESULTS: In total, an alternative diagnosis was found in 31
patients (41.9%), including 13 (36.1%) of 36 patients taking an
anticonvulsant medication. Nineteen patients (25.7%) developed profound
hypotension or bradycardia during the head-up tilt test, confirming the
diagnosis of vasovagal syncope. One other patient had a typical
vasovagal reaction during intravenous cannulation. Two patients
developed psychogenic symptoms during the head-up tilt test. Seven
patients (9.5%) had significant ECG pauses during carotid sinus
massage. In two patients, episodes of prolonged bradycardia correlated
precisely with seizures according to the insertable ECG recorder.
CONCLUSIONS: A simple, noninvasive cardiovascular evaluation may
identify an alternative diagnosis in many patients with apparent
epilepsy and should be considered early in the management of patients
with convulsive blackouts. |
| |
| AD | Manchester Heart Centre, The Royal Infirmary, United Kingdom. mhc.cmht.nwest.nhs.uk. |
| PMID | 10898432 |
Someone told me to research vaso-vagal issues. I'm just digging holes and finding things of course that make me think, "wow, sounds like me in the grocery store the other day - or that happened while I was sitting here."
Medline ® Abstract for Reference 6
of 'Nonepileptic paroxysmal disorders in adolescents and adults'