Fehldiagnose Epilepsie beim Long-QT-Syndrom: Sollte bei jedem Anfall ein EKG abgeleitet werden?

 

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Zusammenfassung

Synkopen stellen eine wichtige und nicht selten schwierige Differenzialdiagnose von epileptischen Anfällen dar. Als eine mögliche Ursache für eine kardiale Synkope kommt ein Long-QT-Syndrom (LQTS) infrage. Als lebensbedrohlich sind bei dieser Erkrankung die Torsade-de-pointes-Tachykardien anzusehen, die zum Herzstillstand durch Kammerflimmern führen können. Vor allem, wenn zu Beginn der Erkrankung die Fehldiagnose Epilepsie gestellt wurde, dauert es meist mehrere Jahre, bis die Diagnose erkannt wird. Nicht selten fällt ein LQTS erst dann auf, wenn die Betroffenen aufgrund eines Herzstillstands reanimiert werden müssen. Um die Fehldiagnose Epilepsie bei LQTS-Patienten zu vermeiden und fatale Krankheitsverläufe rechtzeitig zu verhindern, sollte bei Patienten mit wiederholten Anfällen nicht nur zu Beginn, sondern auch bei erneuten Anfällen im Verlauf jeweils ein EKG abgeleitet und speziell auf die QT-Zeit hin untersucht werden.

Abstract

Syncope is a common and difficult differential diagnosis for epilepsy. One possible cause for a cardiac syncope is a long QT syndrome (LQTS). LQTS with torsade de pointes tachycardia can lead to lethal ventricular fibrillation and cardiac arrest. Patients with LQTS when first diagnosed as suffering from epileptic fits often experience a particularly long diagnostic delay which may even take years. In some cases, the diagnosis of LQTS is not made until the patient needs resuscitation due to a cardiac arrest. Therefore, ECG recording should be performed for every patient presenting with a seizure considered to be of epileptic origin not only at the beginning of the disease but also when fits occur in spite of antiepileptic treatment in order to prevent an incorrect diagnosis and delay in making the correct diagnosis.

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Dr. Lothar Burghaus

Klinik und Poliklinik für Neurologie
Universitätsklinik Köln

Kerpener Str. 62

50924 Köln

Email: lothar.burghaus@uk-koeln.de