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Erschienen in: NeuroTransmitter 4/2015

08.04.2015 | Zertifizierte Fortbildung

Nicht epileptische Anfälle

Vasovagale Synkopen

verfasst von: PD Dr. med. Karl Martin Klein, Prof. Dr. med. Felix Rosenow

Erschienen in: NeuroTransmitter | Ausgabe 4/2015

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Zusammenfassung

Synkopen sind eine häufige Differenzialdiagnose von epileptischen Anfällen und treten bei 25 % der Bevölkerung mindestens einmal im Leben auf. Die häufigste Form sind die vasovagalen Synkopen, die meist durch Trigger wie langes Stehen, Sehen von Blut, Schmerzen, medizinische Prozeduren oder Emotionen ausgelöst werden. Die Pathophysiologie der vasovagalen Synkopen ist nicht vollständig geklärt. Auch genetische Faktoren spielen eine Rolle. In den meisten Fällen liegt ein komplexer Vererbungsmodus vor, bei dem multiple Gene und auch Umgebungsfaktoren eine Rolle spielen.
Literatur
1.
Zurück zum Zitat Chen LY, Shen WK, Mahoney DW et al. (2006) Prevalence of syncope in a population aged more than 45 years. Am. J. Med. 119:1088.e1081–e1087 Chen LY, Shen WK, Mahoney DW et al. (2006) Prevalence of syncope in a population aged more than 45 years. Am. J. Med. 119:1088.e1081–e1087
2.
Zurück zum Zitat Ganzeboom KS, Mairuhu G, Reitsma JB et al. (2006) Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J. Cardiovasc. Electrophysiol. 17:1172–1176CrossRefPubMed Ganzeboom KS, Mairuhu G, Reitsma JB et al. (2006) Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J. Cardiovasc. Electrophysiol. 17:1172–1176CrossRefPubMed
3.
Zurück zum Zitat Thijs RD, Kruit MC, van Buchem MA et al. (2006) Syncope in migraine: the populationbased CAMERA study. Neurology 66:1034–1037CrossRefPubMed Thijs RD, Kruit MC, van Buchem MA et al. (2006) Syncope in migraine: the populationbased CAMERA study. Neurology 66:1034–1037CrossRefPubMed
4.
Zurück zum Zitat Olde Nordkamp LR, van Dijk N, Ganzeboom KS et al. (2009) Syncope prevalence in the ED compared to general practice and population: a strong selection process. Am. J. Emerg. Med. 27:271–279CrossRefPubMed Olde Nordkamp LR, van Dijk N, Ganzeboom KS et al. (2009) Syncope prevalence in the ED compared to general practice and population: a strong selection process. Am. J. Emerg. Med. 27:271–279CrossRefPubMed
5.
Zurück zum Zitat Day SC, Cook EF, Funkenstein H et al. (1982) Evaluation and outcome of emergency room patients with transient loss of consciousness. Am. J. Med. 73:15–23CrossRefPubMed Day SC, Cook EF, Funkenstein H et al. (1982) Evaluation and outcome of emergency room patients with transient loss of consciousness. Am. J. Med. 73:15–23CrossRefPubMed
6.
Zurück zum Zitat Moya A, Sutton R, Ammirati F et al. (2009) Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Eur. Heart J. 30:2631–2671CrossRefPubMedCentralPubMed Moya A, Sutton R, Ammirati F et al. (2009) Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Eur. Heart J. 30:2631–2671CrossRefPubMedCentralPubMed
7.
Zurück zum Zitat Grubb BP (2005) Neurocardiogenic syncope and related disorders of orthostatic intoleranceNeurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation 111:2997–3006CrossRefPubMed Grubb BP (2005) Neurocardiogenic syncope and related disorders of orthostatic intoleranceNeurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation 111:2997–3006CrossRefPubMed
9.
Zurück zum Zitat Barcroft H, Edholm OG, McMichael J et al. (1944) Posthaemorrhagic fainting: study by cardiac output and forearm flow. Lancet 1:489–491CrossRef Barcroft H, Edholm OG, McMichael J et al. (1944) Posthaemorrhagic fainting: study by cardiac output and forearm flow. Lancet 1:489–491CrossRef
10.
Zurück zum Zitat Dietz NM, Halliwill JR, Spielmann JM et al. (1997) Sympathetic withdrawal and forearm vasodilation during vasovagal syncope in humans. J. Appl. Physiol. 82:1785–1793PubMed Dietz NM, Halliwill JR, Spielmann JM et al. (1997) Sympathetic withdrawal and forearm vasodilation during vasovagal syncope in humans. J. Appl. Physiol. 82:1785–1793PubMed
11.
Zurück zum Zitat Epstein SE, Stampfer M, Beiser GD (1968) Role of the capacitance and resistance vessels in vasovagal syncope. Circulation 37:524–533CrossRefPubMed Epstein SE, Stampfer M, Beiser GD (1968) Role of the capacitance and resistance vessels in vasovagal syncope. Circulation 37:524–533CrossRefPubMed
12.
Zurück zum Zitat Jarisch A, Henze C (1937) Über Blutdrucksenkung durch chemische Erregung depressorischer Nerven. Naunyn-Schmiedeberg’s Arch. Exp. Pathol. Pharmak. 187:706–730CrossRef Jarisch A, Henze C (1937) Über Blutdrucksenkung durch chemische Erregung depressorischer Nerven. Naunyn-Schmiedeberg’s Arch. Exp. Pathol. Pharmak. 187:706–730CrossRef
13.
Zurück zum Zitat Jarisch A (1940) Vom Herzen ausgehende Kreislaufreflexe. Arch. Kreislaufforsch. 7:260–274CrossRef Jarisch A (1940) Vom Herzen ausgehende Kreislaufreflexe. Arch. Kreislaufforsch. 7:260–274CrossRef
14.
Zurück zum Zitat von Bezold A, Hirt L (1867) Über die physiologischen Wirkungen des essigsauren Veratrins. Unters. Physiol. Lab. Würzburg 1:75–156 von Bezold A, Hirt L (1867) Über die physiologischen Wirkungen des essigsauren Veratrins. Unters. Physiol. Lab. Würzburg 1:75–156
16.
Zurück zum Zitat Fitzpatrick AP, Banner N, Cheng A et al. (1993) Vasovagal reactions may occur after orthotopic heart transplantation. J. Am. Coll. Cardiol. 21:1132–1137CrossRefPubMed Fitzpatrick AP, Banner N, Cheng A et al. (1993) Vasovagal reactions may occur after orthotopic heart transplantation. J. Am. Coll. Cardiol. 21:1132–1137CrossRefPubMed
17.
Zurück zum Zitat Lightfoot JT, Rowe SA, Fortney SM (1993) Occurrence of presyncope in subjects without ventricular innervation. {tClin Sci (Lond)} 85:695–700 Lightfoot JT, Rowe SA, Fortney SM (1993) Occurrence of presyncope in subjects without ventricular innervation. {tClin Sci (Lond)} 85:695–700
18.
Zurück zum Zitat Scherrer U, Vissing S, Morgan BJ et al. (1990) Vasovagal syncope after infusion of a vasodilator in a heart-transplant recipient. N. Engl. J. Med. 322:602–604CrossRefPubMed Scherrer U, Vissing S, Morgan BJ et al. (1990) Vasovagal syncope after infusion of a vasodilator in a heart-transplant recipient. N. Engl. J. Med. 322:602–604CrossRefPubMed
19.
Zurück zum Zitat Mosqueda-Garcia R, Furlan R, Tank J et al. (2000) The elusive pathophysiology of neurally mediated syncope. Circulation 102:2898–2906CrossRefPubMed Mosqueda-Garcia R, Furlan R, Tank J et al. (2000) The elusive pathophysiology of neurally mediated syncope. Circulation 102:2898–2906CrossRefPubMed
20.
Zurück zum Zitat Camfield PR, Camfield CS (1990) Syncope in childhood: a case control clinical study of the familial tendency to faint. Can. J. Neurol. Sci. 17:306–308PubMed Camfield PR, Camfield CS (1990) Syncope in childhood: a case control clinical study of the familial tendency to faint. Can. J. Neurol. Sci. 17:306–308PubMed
21.
Zurück zum Zitat Kleinknecht RA, Lenz J (1989) Blood/injury fear, fainting and avoidance of medically-related situations: a family correspondence study. Behav. Res. Ther. 27:537–547CrossRefPubMed Kleinknecht RA, Lenz J (1989) Blood/injury fear, fainting and avoidance of medically-related situations: a family correspondence study. Behav. Res. Ther. 27:537–547CrossRefPubMed
22.
Zurück zum Zitat Klein KM, Xu SS, Lawrence K et al. (2012) Evidence for genetic factors in vasovagal syncope: a twin-family study. Neurology 79:561–565CrossRefPubMed Klein KM, Xu SS, Lawrence K et al. (2012) Evidence for genetic factors in vasovagal syncope: a twin-family study. Neurology 79:561–565CrossRefPubMed
23.
Zurück zum Zitat Klein KM, Bromhead CJ, Smith KR et al. (2013) Autosomal dominant vasovagal syncope: clinical features and linkage to chromosome 15q26. Neurology 80:1485–1493CrossRefPubMed Klein KM, Bromhead CJ, Smith KR et al. (2013) Autosomal dominant vasovagal syncope: clinical features and linkage to chromosome 15q26. Neurology 80:1485–1493CrossRefPubMed
24.
25.
Zurück zum Zitat Lempert T, Bauer M, Schmidt D (1994) Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann. Neurol. 36:233–237CrossRefPubMed Lempert T, Bauer M, Schmidt D (1994) Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann. Neurol. 36:233–237CrossRefPubMed
26.
Zurück zum Zitat Strzelczyk A, Cenusa M, Bauer S et al. (2011) Management and long-term outcome in patients presenting with ictal asystole or bradycardia. Epilepsia 52:1160–1167CrossRefPubMed Strzelczyk A, Cenusa M, Bauer S et al. (2011) Management and long-term outcome in patients presenting with ictal asystole or bradycardia. Epilepsia 52:1160–1167CrossRefPubMed
27.
Zurück zum Zitat Olshansky B (2005) Syncope: Overview and approach to management. In: Grubb BP, Olshansky B (eds) Syncope: Mechanisms and management. Blackwell, Massachusetts, USA, Oxford, UK, Carlton, Australia, p 1-46 Olshansky B (2005) Syncope: Overview and approach to management. In: Grubb BP, Olshansky B (eds) Syncope: Mechanisms and management. Blackwell, Massachusetts, USA, Oxford, UK, Carlton, Australia, p 1-46
28.
Zurück zum Zitat Freeman R, Wieling W, Axelrod FB et al. (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Auton Neurosci 161:46–48CrossRefPubMed Freeman R, Wieling W, Axelrod FB et al. (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Auton Neurosci 161:46–48CrossRefPubMed
29.
Zurück zum Zitat Grubb BP, Kosinski DJ, Boehm K et al. (1997) The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing. Pacing Clin. Electrophysiol. 20:2205–2212CrossRefPubMed Grubb BP, Kosinski DJ, Boehm K et al. (1997) The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing. Pacing Clin. Electrophysiol. 20:2205–2212CrossRefPubMed
30.
Zurück zum Zitat Perez-Paredes M, Pico-Aracil F, Florenciano R et al. (1999) Head-up tilt test in patients with high pretest likelihood of neurally mediated syncope: an approximation to the „real sensitivity“ of this testing. Pacing Clin. Electrophysiol. 22:1173–1178CrossRefPubMed Perez-Paredes M, Pico-Aracil F, Florenciano R et al. (1999) Head-up tilt test in patients with high pretest likelihood of neurally mediated syncope: an approximation to the „real sensitivity“ of this testing. Pacing Clin. Electrophysiol. 22:1173–1178CrossRefPubMed
31.
Zurück zum Zitat Fitzpatrick A, Theodorakis G, Vardas P et al. (1991) The incidence of malignant vasovagal syndrome in patients with recurrent syncope. Eur. Heart J. 12:389–394PubMed Fitzpatrick A, Theodorakis G, Vardas P et al. (1991) The incidence of malignant vasovagal syndrome in patients with recurrent syncope. Eur. Heart J. 12:389–394PubMed
32.
Zurück zum Zitat Brignole M, Alboni P, Benditt DG et al. (2004) Guidelines on management (diagnosis and treatment) of syncope—update 2004. Europace 6:467–537CrossRefPubMed Brignole M, Alboni P, Benditt DG et al. (2004) Guidelines on management (diagnosis and treatment) of syncope—update 2004. Europace 6:467–537CrossRefPubMed
33.
Zurück zum Zitat Brignole M, Croci F, Menozzi C et al. (2002) Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J. Am. Coll. Cardiol. 40:2053–2059CrossRefPubMed Brignole M, Croci F, Menozzi C et al. (2002) Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J. Am. Coll. Cardiol. 40:2053–2059CrossRefPubMed
34.
Zurück zum Zitat Krediet CT, van Dijk N, Linzer M et al. (2002) Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing}. Circulation} 106:1684–1689CrossRefPubMed Krediet CT, van Dijk N, Linzer M et al. (2002) Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing}. Circulation} 106:1684–1689CrossRefPubMed
35.
Zurück zum Zitat van Dijk N, Quartieri F, Blanc JJ et al. (2006) Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial). J. Am. Coll. Cardiol. 48:1652–1657CrossRefPubMed van Dijk N, Quartieri F, Blanc JJ et al. (2006) Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial). J. Am. Coll. Cardiol. 48:1652–1657CrossRefPubMed
36.
Zurück zum Zitat El-Sayed H, Hainsworth R (1996) Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 75:134–140CrossRefPubMedCentralPubMed El-Sayed H, Hainsworth R (1996) Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart 75:134–140CrossRefPubMedCentralPubMed
37.
Zurück zum Zitat Romme JJ, Reitsma JB, Go-Schon IK et al. (2010) Prospective evaluation of non-pharmacological treatment in vasovagal syncope. Europace 12:567–573CrossRefPubMed Romme JJ, Reitsma JB, Go-Schon IK et al. (2010) Prospective evaluation of non-pharmacological treatment in vasovagal syncope. Europace 12:567–573CrossRefPubMed
38.
Zurück zum Zitat Di Girolamo E, Di Iorio C, Leonzio L et al. (1999) Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: A controlled study. Circulation 100:1798–1801CrossRefPubMed Di Girolamo E, Di Iorio C, Leonzio L et al. (1999) Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: A controlled study. Circulation 100:1798–1801CrossRefPubMed
39.
Zurück zum Zitat Reybrouck T, Heidbuchel H, Van De Werf F et al. (2002) Long-term follow-up results of tilt training therapy in patients with recurrent neurocardiogenic syncope. Pacing Clin. Electrophysiol. 25:1441–1446CrossRefPubMed Reybrouck T, Heidbuchel H, Van De Werf F et al. (2002) Long-term follow-up results of tilt training therapy in patients with recurrent neurocardiogenic syncope. Pacing Clin. Electrophysiol. 25:1441–1446CrossRefPubMed
40.
Zurück zum Zitat Duygu H, Zoghi M, Turk U et al. (2008) The role of tilt training in preventing recurrent syncope in patients with vasovagal syncope: a prospective and randomized study. Pacing Clin. Electrophysiol. 31:592–596CrossRefPubMed Duygu H, Zoghi M, Turk U et al. (2008) The role of tilt training in preventing recurrent syncope in patients with vasovagal syncope: a prospective and randomized study. Pacing Clin. Electrophysiol. 31:592–596CrossRefPubMed
41.
Zurück zum Zitat Foglia-Manzillo G, Giada F, Gaggioli G et al. (2004) Efficacy of tilt training in the treatment of neurally mediated syncope. A randomized study. Europace 6:199–204 Foglia-Manzillo G, Giada F, Gaggioli G et al. (2004) Efficacy of tilt training in the treatment of neurally mediated syncope. A randomized study. Europace 6:199–204
42.
Zurück zum Zitat On YK, Park J, Huh J et al. (2007) Is home orthostatic self-training effective in preventing neurally mediated syncope? Pacing Clin. Electrophysiol. 30:638–643CrossRef On YK, Park J, Huh J et al. (2007) Is home orthostatic self-training effective in preventing neurally mediated syncope? Pacing Clin. Electrophysiol. 30:638–643CrossRef
43.
Zurück zum Zitat Sheldon R, Connolly S, Rose S et al. (2006) Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 113:1164–1170CrossRefPubMed Sheldon R, Connolly S, Rose S et al. (2006) Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 113:1164–1170CrossRefPubMed
44.
Zurück zum Zitat Sheldon RS, Morillo CA, Klingenheben T et al. (2012) Age-dependent effect of beta-blockers in preventing vasovagal syncope. Circ Arrhythm Electrophysiol 5:920–926CrossRefPubMed Sheldon RS, Morillo CA, Klingenheben T et al. (2012) Age-dependent effect of beta-blockers in preventing vasovagal syncope. Circ Arrhythm Electrophysiol 5:920–926CrossRefPubMed
45.
Zurück zum Zitat Coffin ST, Raj SR (2014) Ongoing Clinical Trials for Vasovagal Syncope: Where are we in 2014? Auton Neurosci 184:77–82 Coffin ST, Raj SR (2014) Ongoing Clinical Trials for Vasovagal Syncope: Where are we in 2014? Auton Neurosci 184:77–82
46.
Zurück zum Zitat Sutton R, Brignole M, Benditt DG (2012) Key challenges in the current management of syncope. Nat Rev Cardiol 9:590–598CrossRefPubMed Sutton R, Brignole M, Benditt DG (2012) Key challenges in the current management of syncope. Nat Rev Cardiol 9:590–598CrossRefPubMed
47.
Zurück zum Zitat Connolly SJ, Sheldon R, Thorpe KE et al. (2003) Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA 289:2224–2229CrossRefPubMed Connolly SJ, Sheldon R, Thorpe KE et al. (2003) Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA 289:2224–2229CrossRefPubMed
48.
Zurück zum Zitat Raviele A, Giada F, Menozzi C et al. (2004) A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). Eur. Heart J. 25:1741–1748 Raviele A, Giada F, Menozzi C et al. (2004) A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). Eur. Heart J. 25:1741–1748
49.
Zurück zum Zitat Brignole M, Menozzi C, Moya A et al. (2012) Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation 125:2566–2571CrossRefPubMed Brignole M, Menozzi C, Moya A et al. (2012) Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation 125:2566–2571CrossRefPubMed
50.
Zurück zum Zitat Crompton DE, Berkovic SF (2009) The borderland of epilepsy: clinical and molecular features of phenomena that mimic epileptic seizures. Lancet Neurol 8:370–381CrossRefPubMed Crompton DE, Berkovic SF (2009) The borderland of epilepsy: clinical and molecular features of phenomena that mimic epileptic seizures. Lancet Neurol 8:370–381CrossRefPubMed
51.
52.
Zurück zum Zitat Sheldon R, Rose S, Ritchie D et al. (2002) Historical criteria that distinguish syncope from seizures. J. Am. Coll. Cardiol. 40:142–148CrossRefPubMed Sheldon R, Rose S, Ritchie D et al. (2002) Historical criteria that distinguish syncope from seizures. J. Am. Coll. Cardiol. 40:142–148CrossRefPubMed
Metadaten
Titel
Nicht epileptische Anfälle
Vasovagale Synkopen
verfasst von
PD Dr. med. Karl Martin Klein
Prof. Dr. med. Felix Rosenow
Publikationsdatum
08.04.2015
Verlag
Urban & Vogel
Erschienen in
NeuroTransmitter / Ausgabe 4/2015
Print ISSN: 1436-123X
Elektronische ISSN: 2196-6397
DOI
https://doi.org/10.1007/s15016-015-0508-4

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