epilepsy

Epileptic Seizures Versus Syncope: Pathophysiology and Clinical Approach

Marios Charalambous, Sergio A. Gomes, Stella Papageorgiou, Massimo Orioles

Published:  28/02/2017    in:  Articles
Views
602
HTML:
3557
PDF:
200



epilepsy
Abstract

Generalised epileptic seizures and syncope are two syndromes with similar clinical manifestation and their differentiation can be quite challenging. The aim of this review is to use an evidence-based approach in differentiating these two syndromes through the comprehension of the pathophysiological mechanisms involved and their clinical signs. Both syndromes affect regions of the forebrain and consciousness level, although, different mechanisms are involved. Syncope is a paroxysmal event secondary to a short-term decrease in cerebral perfusion, oxygenation or essential nutrients delivery. Generalised epileptic seizure activity is defined as the clinical manifestation of transient paroxysmal disturbances in brain function secondary to an imbalance between excitatory and inhibitory neurotransmitters. Clinical criteria, including precipitating events, clinical signs preceding, during and following the episodes and event duration, can be used to differentiate the two syndromes. Although these criteria might be useful for the practitioner, definite conclusions should be precluded due to the lack of original research articles and weak evidence on this specific field.

Application: The review might be a useful tool for the general practitioner and clinical scientist as it will aid towards the differentiation of two syndromes, i.e. generalised epileptic seizures and syncope, with similar clinical presentation.


Open AccessPeer Reviewed
Full Text:

HTML PDF


Click to see References Click to hide References
References

  1. Armijo, J. A. et al (2002) Advances in the physiopathology of epileptogenesis: molecular aspects. Revue Neurologique, 34 (5), pp. 409-29.
  2. Aroniadou-Anderjaska, V. et al (2008) Pathology and pathophysiology of the amygdala in epileptogenesis and epilepsy. Epilepsy Research, 78 (2-3), pp. 102-116. DOI: 1016/j.eplepsyres.2007.11.011
  3. Barnett, L. et al (2010) A retrospective study of 153 cases of undiagnosed collapse, syncope or exercise intolerance: the outcomes. Journal of Small Animal Practice, 52 (1), pp.26-31. http://dx.doi.org/10.1111/j.1748-5827.2010.01013.x
  4. Berendt, M. and Gram, L. (1999) Epilepsy and Seizure Classification in 63 Dogs: A Reappraisal of Veterinary Epilepsy Terminology. Journal of Veterinary Internal Medicine, 13 (1), pp. 14-20. DOI: http://dx.doi.org/10.1111/j.1939-1676.1999.tb02159.x
  5. Boothe, D. M. (2001) Anticonvulsants and other neurologic therapies in small animals. In: Small Animal Clinical Pharmacology and Therapeutics, Philadelphia, Elsevier Saunders.
  6. Bright, J. and Cali, J. (2000) Clinical usefulness of cardiac event recording in dogs and cats examined because of syncope, episodic collapse, or intermittent weakness: 60 cases (1997–1999). Journal of the American Veterinary Medical Association, 216 (7), pp. 1110-1114. DOI: http://dx.doi.org/10.2460/javma.2000.216.1110
  7. Bromfield, E. Cavazos, J. and Sirven, J. (2006) Chapter 1, Basic Mechanisms Underlying Seizures and Epilepsy. In: Bromfield, E., Cavazos, J. and Sirven, J. (2006) An Introduction to epilepsy.West Hartford (CT), American Epilepsy Society., viewed 20 September 2016, <http://www.ncbi.nlm.nih.gov/books/NBK2510/>
  8. Calvert, C. Jacobs, G. and Pickus, C. (1996) Bradycardia-Associated Episodic Weakness, Syncope, and Aborted Sudden Death in Cardiomyopathic Doberman Pinschers. Journal of Veterinary Internal Medicine, 10 (2), pp. 88-93. DOI:http://dx.doi.org/10.1111/j.1939-1676.1996.tb02034.x
  9. Carnes et al. (2006) Management of Canine Idiopathic Epilepsy. Standards of Care Emergency and Critical Care Medicine, 8, pp.1-6.
  10. Davidow, E.B. Woodfield, J.A. (2001) Syncope: Pathophysiology and differential diagnosis. Compendium on Continuing Education for the Practicing Veterinarian, 23, pp. 608–620.
  11. Ettinger, A. J. (1972). Cardiac emergencies. Veterinary Clinics of North America, 2, pp.235-42. DOI: http://dx.doi.org/10.1016/S0091-0279(72)50028-X
  12. Fisher, R. et al. (2005) Epileptic Seizures and Epilepsy: Definitions Proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia, 46 (4), pp. 470-472. DOI: http://dx.doi.org/10.1111/j.0013-9580.2005.66104.x
  13. Folino, A. (2005) Cerebral autoregulation in neurally mediated syncope: victim or executioner?. Heart, 92 (6), pp. 724-726. DOI: http://dx.doi.org/10.1136/hrt.2005.069179
  14. Gompf, R. E. (2008)The history and physical examination. In: Tilley P.L., Smith Jr W.K.F., Oyaman A.M. Manual of Canine and Feline Cardiology, Saunders Elsevier.
  15. Heaven, D. J. Sutton, R. (2000) Syncope. Critical Care Medicine, 28, pp. 116-20. DOI: http://dx.doi.org/10.1097/00003246-200010001-00002
  16. Herman, S. T. (2006) Clinical trials for prevention of epileptogenesis. Epilepsy Research, 68, pp.35-8. DOI: http://dx.doi.org/10.1016/j.eplepsyres.2005.09.015
  17. Jhanjee, R. et al. (2006) Syncope in Adults: Terminology, Classification, and Diagnostic Strategy. Pacing and Clinical Electrophysiology, 29 (10), pp. 1160-1169. DOI: http://dx.doi.org/10.1111/j.1540-8159.2006.00508.x
  18. Kenny, R. A. (2002) Neurally mediated syncope. Clinical Geriatric Medicine, 18, pp. 191-210. DOI:http://dx.doi.org/10.1016/S0749-0690(02)00005-8
  19. Lewis, D. and Dhala, A. (1999) Syncope In The Pediatric Patient: The cardiologist's perspective. Pediatric Clinics of North America, 46 (2), pp. 205-219. DOI: http://dx.doi.org/10.1016/S0031-3955(05)70113-9
  20. Lüders, H. O. et al. (2006) The epileptogenic zone: general principles. Epileptic Disorders, 8 Suppl 2, pp. 1-9. DOI: http://dx.doi.org/10.3109/9780203091708-114
  21. March, P. (1998) Seizures: Classification, etiologies, and pathophysiology. Clinical Techniques in Small Animal Practice, 13 (3), pp. 119-131. DOI: http://dx.doi.org/10.1016/S1096-2867(98)80033-9
  22. Miller, R. et al. (1999) Retrospective Analysis of the Clinical Utility of Ambulatory Electrocardiographic (Holter) Recordings in Syncopal Dogs: 44 Cases (1991-1995). Journal of Veterinary Internal Medicine, 13 (2), pp. 111-122. DOI:http://dx.doi.org/10.1111/j.1939-1676.1999.tb01138.x
  23. Moya, A. et al (2009) Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). European Heart Journal, 30 (21), pp. 2631-2671. DOI:1093/eurheartj/ehp298
  24. Packer, R. (2015) Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists. BMC Veterinary Research, 11 (1), p. 39. DOI: http://dx.doi.org/10.1186/s12917-015-0356-2
  25. Podell, M. (1996) Seizures in Dogs. Veterinary Clinics of North America: Small Animal Practice, 26(4), pp.779-809.
  26. Rogawski, M. (2005) Astrocytes get in the act in epilepsy. Nature Medicine, 11 (9), pp. 919-920.DOI: http://dx.doi.org/10.1038/nm0905-919
  27. Schnipper, J. and Kapoor, W. (2001) Diagnostic Evaluation and Management of Patients with Syncope. Medical Clinics of North America, 85 (2), pp. 423-456. DOI: http://dx.doi.org/10.1016/S0025-7125(05)70321-7
  28. Skrodzki, M. and Trautvetter, (2008) Syncope in dogs-a syndrome, not a disease. Veterinary focus, 18 (3), pp. 36-46.
  29. Strickberger, S. et al. (2006) AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: In Collaboration With the Heart Rhythm Society: Endorsed by the American Autonomic Society. Circulation, 113 (2), pp. 316-327. DOI: 10.1161/CIRCULATIONAHA.105.170274
  30. Tidwell, A. and Robertson, I. (2011) Magnetic Resonance Imaging Of Normal And Abnormal Brain Perfusion. Veterinary Radiology & Ultrasound, 52, pp.S62-S71. DOI: http://dx.doi.org/10.1111/j.1740-8261.2010.01786.x
  31. Yee, K. (2010). Syncope. In: Ettinger JS and Feldman E.C. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO. Saunders Elsevier. pp. 275-77.
  32. Wa, W. (2007). Syncope or intermittent collapse. In: Ware, W. (2007). Cardiovascular disease in small animal medicine. London: Manson/The Veterinary Press.
  33. Waelbers, T. et al (2010). Brain perfusion part 1: regulation mechanisms and measurements of brain perfusion. Diergeneeskd. Tijdschr, 79, pp. 169-177.


Refbacks
  • There are currently no refbacks.


Copyright (c) 2017 Marios Charalambous

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Made possible through a project grant from the RCVS Council.

RCVS