İdiyopatik Epilepsi Tanısı ile İzlenen Hastalarda Epilepsi ile Karışan Kardiak veya Vazovagal Senkop Sıklığı

Yıl 2011, Cilt: 9 Sayı: 1, 94 - 99, 01.06.2011

Mehmet Karacan , Duygu Bidev Haşim Olgun Hüseyin Tan Naci Ceviz

Öz

Giriş: Epilepsi tanısı; geçici şuur kaybının klinik bulguları, aile öyküsü ve elektroensefalografi bulguları birleştirilerek konulur. Epilepsi tanısı ile izlenen hastalardaki yanlış tanıoranının %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 bulgularınvarlığının 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 nöbetözellikleri ve aile öyküleri yeniden sorgulandı ve muayeneleri yapıldı. Tüm hastalaraelektrokardiyografik değerlendirme ve 109 hastaya ekokardiyografik çalışma yapıldı. İhtiyaç duyulduğunda head-up tilt testi, 24 saatlik Holter elektrokardiyografi incelemesive efor testi yapıldı. Bulgular: Geçici şuur kaybına neden olabilecek yapısal kardiyak problem veya aritmihiçbir hastada saptanmadı. Toplam 3 hastada vazovagal senkop saptandı %2,5 . Buhastalar 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 tanıoranlarını azaltabilir

Anahtar Kelimeler

Epilepsi, vazovagal senkop, çocuk

Cardiac or Vasovagal Syncope Misdiagnosed as Idiopathic Epilepsy

Öz

Introduction: Epilepsy is diagnosed by combining the clinical features of the temporaryloss of consciousness, family history and electroencephalography. False diagnosis rateamong patients with epilepsy is reported between 5% and 31.5%. Possible reasons offalse 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 asepilepsy 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 epilepsiwere included in the study. The 62.1% 74/119 of the patients were male, and the meanage 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 electrocardiographywas obtained in all and echocardiography in 109 patients. Head-up tilt table test, 24-hourelectrocardiography 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

Anahtar Kelimeler

Epilepsy, vasovagal syncope, children

Kaynakça

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