ARRHYTHMOGENIC SYNCOPE THAT MIMICS EPILEPSY (CASE REPORT)

Abstract

SUMMARY. According to many studies, overdiagnosis of epilepsy is a common problem, and syncopal states are the main cause of misdiagnosis. The main difficulty in diagnosis is associated with the phenomenon of convulsive syncope. We describe a case of arrhythmogenic syncope in a child that was mistakenly interpreted as a manifestation of epilepsy. Holter ECG monitoring revealed signs of sinus node dysfunction and paroxysmal tachyarrhythmias, which required further diagnosis and treatment by an electrophysiologist. In cases of convulsive syncope, close collaboration between neurologists and cardiologists is necessary to ensure optimal treatment of patients with a diagnostic dilemma of syncope and epileptic seizures and to avoid unnecessary use of antiepileptic drugs.

The aim – to demonstrate, using a clinical case study, the features of electrocardiographic diagnosis of sinus node dysfunction in a patient with syncope and seizures, and to justify the importance of timely diagnosis and treatment.

Material and Methods. Literature publications covering aspects of diagnosis and differential diagnosis of syncopal conditions, including in patients with seizures, are analyzed, and a clinical case of arrhythmogenic syncope mimicking epilepsy is described.

Results. An 11-year-old boy was referred to a pediatric clinic with complaints of dizziness, episodes of loss of consciousness with seizures occurring during physical exertion; he has been treated for epilepsy for a long time without positive results. Holter ECG monitoring revealed sinus node dysfunction, against which frequent paroxysms of tachycardia were recorded. For further examination and correction of treatment, the patient was referred for electrophysiological examination and implantation of a pacemaker.

Conclusions. The use of a multidisciplinary approach is key to establishing the cause of syncope and preventing fatal consequences, such as unnecessary prescription of antiepileptic drugs with their side effects, social restrictions, and, most importantly, failure to treat the true (potentially dangerous) cardiac cause. Long-term ECG monitoring is crucial in the diagnosis of cardiac rhythm and conduction disorders, as it allows establishing a correlation between loss of consciousness, the onset of a seizure, and documented arrhythmia.