Khurana Divya S, Valencia Ignacio, Kruthiventi Seshurao, Gracely Edward, Melvin Joseph J, Legido Agustin, Kothare Sanjeev V
Section of Neurology, St. Christopher's Hospital for Children, Philadelphia, PA 19134, USA.
J Child Neurol. 2006 Oct;21(10):907-10. doi: 10.1177/08830738060210101301.
Episodes of syncope or breath-holding spells are often misdiagnosed as epileptic events. The purpose of this study was to assess the usefulness of an electroencephalogram (EEG) with ocular compression to distinguish breath-holding spells and syncope from epileptic seizures. A retrospective analysis was performed on the EEG records of all children on whom ocular compression was performed from 2000 to 2003. Data from 116 patients with a clinical diagnosis consistent with either syncope or breath-holding spells were compared with a group of 46 patients with epilepsy. The RR interval during ocular compression was significantly higher in syncope patients compared with patients with epilepsy (P < .005). Using 2 seconds of asystole as the cutoff, the sensitivity of ocular compression was 26%, with 100% specificity. The change in RR interval from baseline to ocular compression also distinguished patients with breath-holding spells and syncope from patients with epilepsy. Even a small increase of 0.5 seconds in the RR interval demonstrated a sensitivity of 46%, with a specificity of 98%. Ocular compression performed during an EEG is useful in distinguishing patients with breath-holding spells and syncope from those with epileptic seizures. A requirement of a 2-second period of asystole with ocular compression excludes many patients. Our data indicate that an RR interval increase of 0.5 seconds over baseline identifies additional patients with increased vagal tone. Prompt and accurate diagnosis of the etiology of loss of consciousness might preclude the need for further extensive and expensive evaluation and reduce patient and parental distress.
晕厥或屏气发作常被误诊为癫痫发作。本研究的目的是评估脑电图（EEG）联合眼压迫试验在鉴别屏气发作、晕厥与癫痫发作方面的作用。对2000年至2003年期间所有接受眼压迫试验的儿童的脑电图记录进行回顾性分析。将116例临床诊断为晕厥或屏气发作的患者的数据与46例癫痫患者的一组数据进行比较。与癫痫患者相比，晕厥患者在眼压迫试验期间的RR间期显著更高（P <.005）。以2秒的心脏停搏作为临界值，眼压迫试验的敏感性为26%，特异性为100%。从基线到眼压迫试验期间RR间期的变化也能区分屏气发作和晕厥患者与癫痫患者。即使RR间期仅小幅增加0.5秒，敏感性也达46%，特异性为98%。脑电图检查时进行眼压迫试验有助于鉴别屏气发作和晕厥患者与癫痫发作患者。要求眼压迫试验时出现2秒的心脏停搏会排除许多患者。我们的数据表明，RR间期较基线增加0.5秒可识别出更多迷走神经张力增加的患者。迅速准确地诊断意识丧失的病因可能无需进一步进行广泛且昂贵的评估，并减轻患者及其家长的痛苦。
