Дифференциальная диагностика синкопе и эпилепсии: литературный обзор

Введение. Схожесть клинических проявлений синкопе и эпилепсии зачастую затрудняет их дифференциальную диагностику, что может приводить к неправильной терапевтической тактике, неадекватным лечебным мероприятиям и ухудшению прогноза у пациента. В связи с этим одним из актуальных вопросов современной неврологии является дифференциация критериев, позволяющих точно и своевременно отличить эти состояния.

Цель работы — провести анализ дифференциальных критериев эпилепсии и синкопе, представленных в научной литературе.

Материалы и методы. Выполнен систематический анализ 71 научной работы по теме синкопальных состояний, эпилепсии и оценки дифференциальных критериев, важных в диагностике, опубликованной с 2012 по 2025 г. в открытом доступе. Из них 80,3 % составили иностранные публикации, включая международные клинические рекомендации, систематические обзоры и оригинальные исследования, и около 19,7 % — отечественные источники, представленные клиническими рекомендациями и публикациями в профильных медицинских журналах. Эти работы охватывают широкий спектр вопросов, связанных c синкопе, эпилепсией и их дифференциальными признаками, которые имеют практическое значение для клиницистов. Все выбранные источники отобраны на основе их актуальности, научной новизны и достоверности предоставляемых данных.

Результаты и обсуждение. На основе изученных материалов сформулированы и систематизированы основные клинико-семиологические, инструментальные и биохимические критерии дифференциальной диагностики синкопе и эпилепсии. Выделены особенности начала и течения анализируемых состояний, роль электроэнцефалографии, кардиологического обследования, нейровизуализации и лабораторных показателей в уточнении диагноза и исключении альтернативной патологии.

Заключение. Для дифференциальной диагностики синкопе и эпилепсии необходимо комплексно учитывать анамнез заболевания, особенности клинических проявлений, биохимические маркеры и результаты инструментальных исследований. Такой подход позволяет повысить точность диагноза и оптимизировать терапевтическую тактику.

1. Aretinskiy AV, Zhilyakov AV, Aretinskiy VB, Shershever AS, Isupov AB, Shorikov EV. Utility of 18F-FDG PET/CT in the diagnostics of epilepsy. Ural Medical Journal. 2019;(3):25–29. (In Russ.). EDN: https://elibrary.ru/RVQETL.

2. Marachuyeva FA, Geibatova LG. Predictors of symptomatic epilepsy in children with neurodevelopmental disorders. Ural Medical Journal. 2018;(12):32–35. (In Russ.). EDN: https://elibrary.ru/VYMAUK.

3. Sozonov AV, Tsarkova SA, Trunova YA. Pediatric chest pain and synopsis is a current problem of pediatrics. Ural Medical Journal. 2023;22(3):137–144. (In Russ.). DOI: http://doi.org/10.52420/2071-5943-2023-22-3-137-144.

4. Tyuryupov MS, Shershneva AA, Butikov VP, Kutelev GG. Modern methods of diagnostics of syncopal conditions in servicemen. Russian Military Medical Academy Reports. 2024;43(3):351–360. (In Russ.). DOI: https://doi.org/10.17816/rmmar632698.

5. Kantimirova EA, Dmitrenko DV. Issues related to differential diagnosis of epilepsy and narcolepsy. Epilepsy and Paroxysmal Conditions. 2024;16(4):327–332. (In Russ.). DOI: https://doi.org/10.17749/2077-8333/epi.par.con.2024.197.

6. Dzhioeva ON, Reznik EV, Nikitin IG. Differential diagnostics of syncopal conditions. Cardiovascular Therapy and Prevention. 2019;18(2):76–83. (In Russ.). DOI: https://doi.org/10.15829/1728-8800-2019-2-76-83.

7. Сhebanenko NV, Mironov MB, Burd SG, Kudrayvtzeva OI, Sarzhina MN, Gunchenko MM, et al. Differential diagnosis of epileptic seizures in cryptogenic focal frontal lobe epilepsy versus psychogenic non-epileptic paroxysms (a case report). Epilepsy and Paroxysmal Conditions. 2017;9(2):50–56. (In Russ.). DOI: https://doi.org/10.17749/2077-8333.2017.9.2.050-056.

8. Shova NI, Bolshakova AK, Mikhailov VA. Epilepsy and sleep: Current diagnostic and treatment approaches. Epilepsy and Paroxysmal Conditions. 2024;16(4):362–374. (In Russ.). DOI: https://doi.org/10.17749/2077-8333/epi.par.con.2024.194.

9. Kuzenkova LM, Shaytor VM, Globa OV, Tepayev RF. Epileptic and non-epileptic paroxysmal states in children. Principles of diagnosis and therapy. Pediatric Pharmacology. 2016;13(1):38–43. (In Russ., Eng.). DOI: https://doi.org/10.15690/pf.v13i1.1513.

10. Aivazyan SO. Non epileptic paroxysmal events imitating epilepsy in children. Epilepsy and Paroxysmal Conditions. 2016;8(4):23–33. (In Russ.). DOI: https://doi.org/10.17749/2077-8333.2016.8.4.023-033.

11. Shnayder NA. Video monitoring of electroencephalography at epilepsy. Siberian Medical Review. 2016;(2):93– 105. (In Russ.). EDN: https://elibrary.ru/WEFKKN.

12. Shekh-Ahmad T, Kovac S, Abramov AY, Walker MC. Reactive oxygen species in status epilepticus. Epilepsy & Behavior. 2019;101(Pt B):106410. DOI: https://doi.org/10.1016/j.yebeh.2019.07.011.

13. Wardrope A, Newberry E, Reuber M. Diagnostic criteria to aid the differential diagnosis of patients presenting with transient loss of consciousness: A systematic review. Seizure: European Journal of Epilepsy. 2018;61:139–148. DOI: https://doi.org/10.1016/j.seizure.2018.08.012.

14. Patel J, Tran QK, Martinez S, Wright H, Pourmand A. Utility of serum lactate on differential diagnosis of seizure-like activity: A systematic review and meta-analysis. Seizure: European Journal of Epilepsy. 2022;102:134–142. DOI: https://doi.org/10.1016/j.seizure.2022.10.007.

15. Falco-Walter J. Epilepsy — definition, classification, pathophysiology, and epidemiology. Seminars in Neurology. 2020;40(6):617–623. DOI: https://doi.org/10.1055/s-0040-1718719.

16. Shaik AJ, Reddy K, Mohammed N, Tandra SR, Rukmini Mridula Kandadai, Baba KSS S. Neuron specific enolase as a marker of seizure related neuronal injury. Neurochemistry International. 2019;131:104509. DOI: https://doi.org/10.1016/j.neuint.2019.104509.

17. Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2017;70(5):e39–e110. DOI: https://doi.org/10.1016/j.jacc.2017.03.003. Erratum in: Journal of the American College of Cardiology. 2017;70(16):2102–2104. DOI: https://doi.org/10.1016/j.jacc.2017.08.024.

18. Nass RD, Sassen R, Elger CE, Surges R. The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure: European Journal of Epilepsy. 2017;47:51–65. DOI: https://doi.org/10.1016/j.seizure.2017.02.013.

19. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al.; ESC Scientific Document Group. 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal. 2018;39(21):1883–1948. DOI: https://doi.org/10.1093/eurheartj/ehy037.

20. Matz O, Zdebik C, Zechbauer S, Bündgens L, Litmathe J, Willmes K, et al. Lactate as a diagnostic marker in transient loss of consciousness. Seizure: European Journal of Epilepsy. 2016;40:71–75. DOI: https://doi.org/10.1016/j.seizure.2016.06.014.

21. King SA, Spangler R, Dezman ZDW, Bontempo LJ. 36 year-old male with syncope: Case report. Clinical Practice and Cases in Emergency Medicine. 2020;4(3):272–276. DOI: https://doi.org/10.5811/cpcem.2020.6.48419.

22. Imad H, Johan Z, Eva K. Hypoglycemia and risk of seizures: A retrospective cross-sectional study. Seizure: European Journal of Epilepsy. 2015;25:147–149. DOI: https://doi.org/10.1016/j.seizure.2014.10.005.

23. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–530. DOI: https://doi.org/10.1111/epi.13670.

24. Sabu J, Regeti K, Mallappallil M, Kassotis J, Islam H, Zafar S, et al. Convulsive syncope induced by ventricular arrhythmia masquerading as epileptic seizures: Case report and literature review. Journal of Clinical Medicine Research. 2016;8(8):610–615. DOI: https://doi.org/10.14740/jocmr2583w.

25. Runser LA, Gauer RL, Houser A. Syncope: Evaluation and differential diagnosis. American Family Physician. 2017;95(5):303–312. PMID: https://pubmed.gov/28290647.

26. Xia Y, Lai W, Li S, Wen Z, Chen L. Differentiation of epilepsy and psychogenic nonepileptic events based on body fluid characteristics: Epilepsia Open. 2023;8(3):959–968. DOI: https://doi.org/10.1002/epi4.12775.

27. Liampas A, Markoula S, Zis P, Reuber M. Psychogenic non-epileptic seizures (PNES) in the context of concurrent epilepsy — making the right diagnosis. Acta Epileptologica. 2021;3:23. DOI: https://doi.org/10.1186/s42494-021-00057-x.

28. Masoumi В, Mozafari S, Golshani A, Heydari F, Nasr-Esfahani M. Differential diagnosis of seizure and syncope by the means of biochemical markers in emergency department patients. International Journal of Preventive Medicine. 2022;13(1):58. DOI: https://doi.org/10.4103/ijpvm.IJPVM_129_20.

29. Rakhmanina ОA, Volkov IV, Tomenko ТR, Shestakova OI, Volkova ОК. Dynamics of management of monogenic epilepsies, developmental and epileptic encephalopathies in routine clinical practice. Russian Journal of Child Neurology. 2025;19(4):10–19. DOI: https://doi.org/10.17650/2073-8803-2024-19-4-10-19.

30. Ghalib S, Chopra A, Fantauzzi JP, Nabagiez JP, Tiwari A. A young woman with recurrent episodes of fever and cough. Chest. 2021;160(1):e25–e28. DOI: https://doi.org/10.1016/j.chest.2021.01.042.

31. El-Hussein MT, Cuncannon A. Syncope in the emergency department: A guide for clinicians. Journal of Emergency Nursing. 2021;47(2):342–351. DOI: https://doi.org/10.1016/j.jen.2020.11.002.

32. Bhatia S, Godfrey M, Hamandi K. Cortical oscillations as seizure markers in photosensitive epilepsy. Clinical Medicine. 2019;19 (3 Suppl): s85. DOI: https://doi.org/10.7861/clinmedicine.19-3s-s85.

33. Duplyakov D, Golovina G, Lyukshina N, Surkova E, Elger CE, Surges R. Syncope, seizure-induced bradycardia and asystole: Two cases and review of clinical and pathophysiological features. Seizure: European Journal of Epilepsy. 2014;23(7):506–511. DOI: https://doi.org/10.1016/j.seizure.2014.03.004.

34. Okudan Z, Özkara Ç. Reflex epilepsy: Triggers and management strategies. Neuropsychiatric Disease and Treatment. 2018;14:327–337. DOI: https://doi.org/10.2147/NDT.S107669.

35. Lombardi N, Scévola L, Sarudiansky M, Giagante B, Gargiulo A, Alonso N, et al. Differential semiology based on video electroencephalography monitoring between psychogenic nonepileptic seizures and temporal lobe epileptic seizures. Journal of the Academy of Consultation-Liaison Psychiatry. 2021;62(1):22–28. DOI: https://doi.org/10.1016/j.psym.2020.07.003.

36. Anzellotti F, Dono F, Evangelista G, Di Pietro M, Carrarini C, Russo M, Ferrante C, Sensi SL, Onofrj M. Psychogenic non-epileptic seizures and pseudo-refractory epilepsy, a management challenge. Frontiers in Neurology. 2020;11:461. DOI: https://doi.org/10.3389/fneur.2020.00461.

37. Dearbhla K, Costello D. Syncope-induced convulsions in adults: A case series. Clinical Medicine. 2016;16(5):461– 463. DOI: https://doi.org/10.1212/WNL.86.16_supplement.P4.223.

38. Beversdorf A. Syncope in the pediatric patient: A case report. Journal of Pediatric Health Care. 2019;33(3):332– 335. DOI: https://doi.org/10.1016/j.pedhc.2018.09.008.

39. Coleman DK, Long B, Koyfman A. Clinical mimics: An emergency medicine — focused review of syncope mimics. Journal of Emergency Medicine. 2018;54(1):81–89. DOI: https://doi.org/10.1016/j.jemermed.2017.09.012.

40. Sobregrau P, Baillès E, Radua J, Carreño M, Donaire A, Setoain X, et al. Design and validation of a diagnostic suspicion checklist to differentiate epileptic from psychogenic nonepileptic seizures (PNES-DSC). Journal of Psychosomatic Research. 2024;180:111656. DOI: https://doi.org/10.1016/j.jpsychores.2024.111656.

41. Hanin A, Demeret S, Denis JA, Nguyen-Michel VH, Rohaut B, Marois C, et al. Serum neuron-specific enolase: A new tool for seizure risk monitoring after status epilepticus. European Journal of Neurology. 2022;29(3):883–889. DOI: https://onlinelibrary.wiley.com/doi/10.1111/ene.15154.

42. Akel S, Hosseini Ashtiani S, Sarangdhar MA, Axelsson M, Zelano J. Blood biomarkers of seizures in epilepsy: Machine learning reveals altered plasma proteome. BMJ Neurology Open. 2025;7(2):e001321. DOI: https://doi.org/10.1136/bmjno-2025-001321.

43. Wardrope A, Ferrar M, Goodacre S, Habershon D, Heaton TJ, Howell SJ, et al. Validation of a machine-learning clinical decision aid for the differential diagnosis of transient loss of consciousness. Neurology Clinical Practice. 2025;15(2):200448. DOI: https://doi.org/10.1212/CPJ.0000000000200448.

44. Karpuzcu H, Kışlal FM, Ardıçlı D, Yılmaz D. Electroencephalography in the differential diagnosis of nonepileptic paroxysmal events in infants: Clinical utility and other predictors. Seizure: European Journal of Epilepsy. 2026;136:77–85. DOI: https://doi.org/10.1016/j.seizure.2026.02.006.

45. Bullinger K, Dhakar M, Pearson A, Bumanglang A, Guven E, Verma R, et al. Retrospective discrimination of PNES and epileptic seizure types using blood RNA signatures. Journal of Neurology. 2025;272:128. DOI: https://doi.org/10.1007/s00415-024-12877-1.

46. Pevy N, Christensen H, Walker T, Reuber M. Predicting the cause of seizures using features extracted from interactions with a virtual agent. Seizure: European Journal of Epilepsy. 2024;114:84–89. DOI: https://doi.org/10.1016/j.seizure.2023.11.022.

47. Ahmed A, Patil PS. Identifying myoclonic epilepsy misdiagnosed as psychogenic nonepileptic seizures: Challenges in differential diagnosis. Cureus. 2024;16(6):e62653. DOI: https://doi.org/10.7759/cureus.62653.

48. Jin SJ, Lee HE, Moon HE, Park ES, Lee SH, Roh YI, et al. Classification model for epileptic seizure using simple postictal laboratory indices. Journal of Clinical Medicine. 2023;12(12):4031. DOI: https://doi.org/10.3390/jcm12124031.

49. Misirocchi F, Vaudano AE, Florindo I, Zinno L, Zilioli A, Mannini E, et al. Imaging biomarkers of sleeprelated hypermotor epilepsy and sudden unexpected death in epilepsy: A review. Seizure: European Journal of Epilepsy. 2023;114:70–78. DOI: https://doi.org/10.1016/j.seizure.2023.12.001.

50. Peltola ME, Leitinger M, Halford JJ, Vinayan KP, Kobayashi K, Pressler RM, et al. Routine and sleep EEG: Minimum recording standards of the International Federation of Clinical Neurophysiology and the International League Against Epilepsy. Epilepsia. 2023;64(3):602–618. DOI: https://doi.org/10.1111/epi.17448.

51. Kasteleijn-Nolst Trenité D, Rubboli G, Hirsch E, Martins da Silva A, Seri S, Wilkins A, et al. Methodology of photic stimulation revisited: Updated European algorithm for visual stimulation in the EEG laboratory. Epilepsia. 2012;53(1):16–24. DOI: https://doi.org/10.1111/j.1528-1167.2011.03319.x.

52. Verma R, Bullinger KL, Pearson A, Dhakar M, Guven E, Amini E, et al. Differential transcript expression and alternative RNA splicing patterns to differentiate focal vs. generalized-onset seizures. Molecular Neurobiology. 2025;62:13303–13317. DOI: https://doi.org/10.1007/s12035-025-05110-1.

53. Albadareen R, Gronseth G, Landazuri P, He J, Hammond N, Uysal U. Postictal ammonia as a biomarker for electrographic convulsive seizures: A prospective study. Epilepsia. 2016;57(8):1221–1227. DOI: https://doi.org/10.1111/epi.13426.

54. Shijun Y, Li S, Wang H, Li J, Wang C, Liu Q, et al. Early prediction of drug-resistant epilepsy using clinical and EEG features based on convolutional neural network. Seizure: European Journal of Epilepsy. 2023;114:98– 104. DOI: https://doi.org/10.1016/j.seizure.2023.12.009.

55. Bahhah MA, Attar ET. Enhancing epilepsy seizure detection through advanced EEG preprocessing techniques and peak-to-peak amplitude fluctuation analysis. Diagnostics. 2024;14(22):2525. DOI: https://doi.org/10.3390/diagnostics14222525.

56. Saad K. Childhood epilepsy: An update on diagnosis and management. American Journal of Neuroscience. 2014;5(2):36.51. DOI: https://doi.org/10.3844/amjnsp.2014.36.51.

57. Ungar A, Ceccofiglio A, Pescini F, Mussi C, Tava G, Rafanelli M, et al. Syncope and epilepsy coexist in ‘possible’ and ‘drug-resistant’ epilepsy (overlap between epilepsy and syncope study — OESYS). BMC Neurology. 2017;17(1):45. DOI: https://doi.org/10.1186/s12883-017-0822-5.

58. Muppidi S, Razavi B, Miglis M, Jardeh S. Utility of electroencephalography (EEG) during tilt table evaluation for syncope (P5.328). Neurology. 2017;88(16 Suppl):328. DOI: https://doi.org/10.1212/WNL.88.16_supplement.P5.328.

59. El‐Naggar H, Moloney P, Widdess‐Walsh P, Kilbride R, Delanty N, Mullins G. Simultaneous occurrence of nonepileptic and epileptic seizures during a single period of in‐patient video‐electroencephalographic monitoring. Epilepsia Open. 2017;2(4):467–471. DOI: https://doi.org/10.1002/epi4.12071.

60. Formica C, Gjonaj E, Bonanno L, Quercia A, Cartella E, Romeo L, et al. The role of high-density EEG in diagnosis and prognosis of neurological diseases: A systematic review. Clinical Neurophysiology. 2025;174:37–47. DOI: https://doi.org/10.1016/j.clinph.2025.03.026.

61. Whitfield A, Wardrope A, Ardern K, Garlovsky J, Oto M, Reuber M. Subjective seizure symptom reporting in functional/dissociative seizures and epilepsy: Effects of sampling technique and patient characteristics. Epilepsy & Behavior. 2023;145:109331. DOI: https://doi.org/10.1016/j.yebeh.2023.109331.

62. Yan J, Wang Y, Wang L, Jin W, Du C, Li G, et al. Whether radiofrequency thermocoagulation guided by stereotactic electroencephalography can benefit drug-resistant epilepsy in the early follow-up stage. Acta Epileptologica. 2025;7(1):16. DOI: https://doi.org/10.1186/s42494-025-00207-5.

63. Khan OI, Azevedo CJ, Hartshorn AL, Montanye JT, Gonzalez JC, Natola MA, et al. A comparison of continuous video-EEG monitoring and 30 minute EEG in an ICU. Epileptic Disorders. 2014;16(4):439–448. DOI: https://doi.org/10.1684/epd.2014.0715.

64. Chen G, Zhang Z, Wang M, Geng Y, Jin B, Aung T. Update on the neuroimaging and electroencephalographic biomarkers of epileptogenesis: A literature review. Frontiers in Neurology. 2021;12:738658. DOI: https://doi.org/10.3389/fneur.2021.738658.

65. Helmstaedter C, Meschede C, Mastani S, Moskau-Hartmann S, Rademacher M, von Wrede R, et al. Normalization and cross-sectional validation of an extended Adverse Event Profile (E AEP) in a large cohort of patients with epilepsy. Seizure: European Journal of Epilepsy. 2023;114:9–17. DOI: https://doi.org/10.1016/j.seizure.2023.11.010.

66. She Y, Zhou L, Li Y. Interpretable machine learning models for predicting 90 day death in patients in the intensive care unit with epilepsy. Seizure: European Journal of Epilepsy. 2023;114:23–32. DOI: https://doi.org/10.1016/j.seizure.2023.11.017.

67. Sun H, Ma D, Hou S, Zhang W, Li J, Zhao W, et al. Exploring causal correlations between systemic inflammatory cytokines and epilepsy: A bidirectional Mendelian randomization study. Seizure: European Journal of Epilepsy. 2023;114:44–49. DOI: https://doi.org/10.1016/j.seizure.2023.11.006.

68. Husain AM, Towne AR, Chen DK, Whitmire LE, Voyles SR, Cardenas DP. Differentiation of epileptic and psychogenic nonepileptic seizures using single-channel surface electromyography. Journal of Clinical Neurophysiology. 2021;38(5):432–438. DOI: https://doi.org/10.1097/WNP.0000000000000703.

69. Seçen AE, Akçalı DT, Kurt G. The S100B protein in epilepsy. Archives of Epilepsy. 2023;29(2):37–40. DOI: https://doi.org/10.4274/ArchEpilepsy.2023.231289.