0444: Usefulness of combined head-up tilt testing with video-EEG monitoring in the evaluation of patients with atypical seizure-like unexplained loss of consciousness - 07/02/15
Résumé |
Background |
It is well established that tonic-clonic seizure-like activity can be part of a syncope yet many patients with these clinical features are misdiagnosed with seizures and often referred to epilepsy centers. Head-up tilt test (HUT) is the gold standard for diagnosing vasovagal syncope, but it can fail to provide clinical details that help distinguish convulsive syncope from epileptic seizures. We aimed to evaluate the diagnostic yield of a combined HUT and video-EEG monitoring strategy in patients with atypical episodes of unexplained loss of consciousness (LOC).
Methods and results |
A total of 87 patients (mean age 32±15 years, 71% women) who underwent HUT with concomitant video-EEG between March 2007 and August 2013 were retrospectively analyzed. Events were classified as vasovagal syncope, epilepsy or psychogenic. Median number of episodes of LOC was 6 [range 1 - 30]. 45% of patients had prolonged LOC (>1 min), 75% had myoclonic jerks and 52% abnormal standard EEG. Antiepileptic drugs (AEDs) were prescribed in 38 patients (43%). The majority of patients (78/87) had undergone prior neurological and cardiac evaluation with routine EEG, neuroimaging and/or Holter ECG, and HUT (n=30). HUT combined with video-EEG was diagnostic in 67/87 (77%) of patients. Vasovagal syncope was seen in 62/87 (71%), 31 of which had associated myoclonic jerks, especially dose with severe bradycardia <40 bpm (n=26) or asystole (n=5). Five patients (6%) experienced psychogenic non-epileptic events. Epilepsy was diagnosed in only 8 patients (9%), and LOC remained unexplained in 12 (14%). AEDs were discontinued in non-epileptic patients as a result of the testing.
Conclusions |
Patients with convulsive syncope are often misdiagnosed and treated with AEDs. Combined HUT and video-EEG monitoring is a useful diagnostic test in patients with atypical episodes of unexplained LOC and can avoid expensive non-diagnostic evaluations as well as ongoing treatment with unnecessary AEDs.
Le texte complet de cet article est disponible en PDF.Vol 7 - N° 1
P. 75 - janvier 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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