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Vol. 59. Núm. 5.
Páginas 441-447 (Noviembre 2003)
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Vol. 59. Núm. 5.
Páginas 441-447 (Noviembre 2003)
Acceso a texto completo
Síncope convulsivo: características y reproducibilidad mediante la prueba de la cama basculante
Convulsive syncope: characteristics and reproducibility using the tilt test
Visitas
...
M. Fernández Sanmartína,
Autor para correspondencia
mfsanmartin@mixmail.com

Correspondencia: A Choupana, s/n. 15706 Santiago de Compostela. España.
, A. Rodríguez Núñeza, F. Martinón-Torresa, J. Eirís Puñalb, J.M. Martinón Sáncheza
a Departamento de Pediatría. Servicio de Críticos y Urgencias Pediátricas. España
b Departamento de Pediatría. Servicio de Neuropediatría. Hospital Clínico Universitario. Santiago de Compostela. España
Información del artículo
Objetivos

Establecer las principales características clínicas del síncope convulsivo y la utilidad del test de la cama basculante (tilt-test) en su diagnóstico.

Métodos

317 pacientes (5-18 años) con sospecha clínica de síncope neurocardiogénico, fueron sometidos a un test de la cama basculante multiparamétrico con: monitorización electrocardiográfica continua, medición continua y no invasiva de la presión arterial, pulsioximetría y medición de la saturación de oxígeno cerebral continua y no invasiva por espectrofotometría de infrarrojo cercano. En pacientes seleccionados se realizó registro electroencefalográfico simultáneo.

Resultados

La prueba resultó positiva en 216 pacientes (68,1 %). De ellos, 25 (11,6 %) presentaron manifestaciones convulsivas durante la misma (síncope convulsivo). Las crisis fueron de tipo tónico asimétrico en 15 pacientes (60%), tónico generalizado en cinco (20 %) y tonicoclónico en los 5 restantes (20%). En todos los casos la duración de la crisis fue menor a 30 s y cedió de forma espontánea con el posicionamiento en horizontal o Trendelenburg. En los pacientes en los que se realizó estudio electroencefalográfico simultáneo se observó un enlentecimiento difuso del trazado de base, no evidenciándose en ninguno de ellos elementos agudos de características epileptógenas.

Conclusiones

El síncope convulsivo es una entidad relativamente frecuente en los niños que son estudiados mediante el test de la cama basculante. Este hecho debe ser conocido por el pediatra, para evitar la asociación unidireccional que muchas veces se establece entre convulsiones y enfermedad epiléptica. En consecuencia, el test de la cama basculante debe considerarse una prueba esencial en el diagnóstico diferencial entre síncope y epilepsia.

Palabras clave:
Síncope
Convulsión
Síncope vasovagal
Síncope convulsivo
Test de la cama basculante
Pediatría
Objectives

To establish the main clinical characteristics of convulsive syncope and the usefulness of the tilt test in its diagnosis.

Methods

A total of 317 patients (aged 5-18 years old) under clinical suspicion of neurocardiogenic syncope underwent a multiparametric tilt test. Our tilt test protocol includes continuous noninvasive measurement of heart rate, blood pressure, and arterial oxygen saturation, as well as continuous noninvasive measurement of cerebral oxygen saturation by near-infrared spectrophotometry. In selected patients, simultaneous electroencephalogram (EEG) was performed.

Results

The tilt test was positive in 216 patients (68.1 %). Of these, 25 (11.6 %) showed seizures during the test (convulsive syncope). Convulsions were asymmetric-tonic in 15 patients (60 %), generalized tonic in 5 (20 %), and tonic-clonic in 5 (20 %). In all patients, convulsive episodes lasted less than 30 seconds and spontaneously ceased upon placing the patient in a horizontal or Trendelenburg position. When simultaneous EEG was performed, diffuse brain wave slowing was observed, without paroxysmal activity.

Conclusions

Convulsive syncope is not an uncommon event in children and is easily elicited by means of the tilt test. Pediatricians should be aware of this finding in order to avoid the frequently established unidirectional association between seizures and epileptic disorders. Consequently, the tilt test should be considered an essential tool in the differential diagnosis between convulsive syncope and epilepsy.

Key words:
Syncope
Seizure
Vasovagal syncope
Convulsive syncope
Head upright tilt-table test
Pediatrics
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