Synkope, epileptischer oder psychogener Anfall? Der Weg zur richtigen Diagnose

Der kurzzeitige Bewusstseinsverlust ist ein häufiges Symptom in der Notfallversorgung. Differenzialdiagnostisch müssen Synkopen u. a. von epileptischen oder psychogenen Anfällen unterschieden werden, Fehleinschätzungen sind nicht selten. Dieser Artikel soll dazu befähigen, entscheidende klinische Kernsymptome systematisch zu erheben und so die Ursache des kurzzeitigen Bewusstseinsverlustes mit hoher Sicherheit abzuleiten.

• Literatur

• 1 Xu Y, Nguyen D, Mohamed A. et al. Frequency of a false positive diagnosis of epilepsy: A systematic review of observational studies. Seizure 2016; 41: 167-174
• 2 Benke T, Hochleitner M, Bauer G. Aura phenomena during syncope. Eur Neurol 1997; 37: 28-32
• 3 Wieling W, Thijs RD, van Dijk N. et al. Symptoms and signs of syncope: a review of the link between physiology and clinical clues. Brain 2009; 132: 2630-2642
• 4 Lempert T. Recognizing syncope: pitfalls and surprises. J R Soc Med 1996; 89: 372-375
• 5 Shmuely S, Bauer PR, van Zwet EW. et al. Differentiating motor phenomena in tilt-induced syncope and convulsive seizures. Neurology 2018; 90: e1339-e1346
• 6 Brignole M, Moya A, de Lange FJ. ESC Scientific Document Group. et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018; 39: 1883-1948
• 7 Fisher RS, Acevedo C, Arzimanoglou A. et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014; 55: 475-482
• 8 Elwan S, Alexopoulos A, Silveira DC. et al. Lateralizing and localizing value of seizure semiology: Comparison with scalp EEG, MRI and PET in patients successfully treated with resective epilepsy surgery. Seizure 2018; 61: 203-208
• 9 Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia 2006; 47: 1499-1503
• 10 Reuber M. Psychogenic nonepileptic seizures: answers and questions. Epilepsy Behav 2008; 12: 622-635
• 11 Mostacci B, Bisulli F, Alvisi L. et al. Ictal characteristics of psychogenic nonepileptic seizures: what we have learned from video/EEG recordings-a literature review. Epilepsy Behav 2011; 22: 144-153
• 12 Seneviratne U, Minato E, Paul E. How reliable is ictal duration to differentiate psychogenic nonepileptic seizures from epileptic seizures?. Epilepsy Behav 2017; 66: 127-131
• 13 Nass RD, Sassen R, Elger CE. et al. The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure 2017; 47: 51-65