Sakakibara-Hayashi Kozue, Inoue Takeshi, Kuki Ichiro, Usui Masakatsu, Ikeda Akio, Kanda Masutaro
Department of Neurology, Kyoto University Graduate School of Medicine.
Child and Adolescent Epilepsy Center, Pediatric Neurology, Osaka City General Hospital.
Rinsho Shinkeigaku. 2020 Sep 29;60(9):627-630. doi: 10.5692/clinicalneurol.cn-001451. Epub 2020 Aug 8.
A 17-year-old woman presented with transient consciousness impairment attack and convulsion after bathing and prolonged standing since age 12. EEG showed WHAM ( wake, high amplitude, anterior, male) type of phantom spikes that usually carry the high risk of epilepsy at age 13. At age 17, EEG wise generalized spike and wave complex was recorded once, and head-up tilt test was positive. She was carefully observed without antiepileptic drugs since convulsive syncope due to neurally mediated syncope was most likely. During the follow-up period, she had eventually unprovoked generalized tonic-clonic seizures (convulsive seizure) twice and thus she was started with antiepileptic drug with success. Although both convulsive syncope and convulsive seizure differ in nature and effects on quality of life, in this patient, the latter occurred later and both occurs together. It is important to distinguish them by means of the degree of convulsion and EEG finding.
一名17岁女性自12岁起在洗澡及长时间站立后出现短暂意识障碍发作和抽搐。脑电图显示为WHAM（清醒、高波幅、前部、男性）型幻像棘波，在13岁时通常提示癫痫高风险。17岁时，脑电图记录到一次广泛性棘慢复合波，直立倾斜试验呈阳性。由于最可能是神经介导性晕厥导致的惊厥性晕厥，因此在未使用抗癫痫药物的情况下对她进行了密切观察。在随访期间，她最终无诱因地出现了两次全身性强直阵挛发作（惊厥发作），因此开始使用抗癫痫药物并取得了成功。尽管惊厥性晕厥和惊厥发作在性质和对生活质量的影响方面有所不同，但在该患者中，后者出现较晚且两者同时发生。通过抽搐程度和脑电图检查结果来区分它们很重要。
