Cardiac or Vasovagal Syncope Misdiagnosed as Idiopathic Epilepsy - Original Article

Introduction: Epilepsy is diagnosed by combining the clinical features of the temporary loss of consciousness, family history and electroencephalography. False diagnosis rate among patients with epilepsy is reported between 5% and 31.5%. Possible reasons of false 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 as epilepsy 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 epilepsi were included in the study. The 62.1% (74/119) of the patients were male, and the mean age 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 electrocardiography was obtained in all and echocardiography in 109 patients. Head-up tilt table test, 24-hour electrocardiography 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 to evaluation of the results of electroencephalography and tilt test results may lower the false diagnosis rate. (Journal of Current Pediatrics 2010; 8: 94-9)