Differentiation of Convulsive Syncope and Epilepsy with Head-Up Tilt Testing

Grubb, Blair P.; Gerard, Gary F.; Roush, Kenneth; Temesy‐Armos, Peter; Elliott, Laura; Hahn, Harry; Spann, Claudia

doi:10.7326/0003-4819-115-11-871

Cited by 145 publications

(78 citation statements)

References 35 publications

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“…Situational syncope is relatively uncommon in adolescents. Central vasovagal syncope is typically independent of body position 8,9 and is fairly common in the young. However, the most common variant in adolescents is postural syncope, which occurs when upright and is relieved by recumbency.…”

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confidence: 99%

Relation of Postural Vasovagal Syncope to Splanchnic Hypervolemia in Adolescents

Stewart

McLeod²,

Sanyal³

et al. 2004

Circulation

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Background-The mechanisms of simple faint remain elusive. We propose that postural fainting is related to excessive thoracic hypovolemia and splanchnic hypervolemia during orthostasis compared with healthy subjects. Methods and Results-We studied 34 patients 12 to 22 years old referred for multiple episodes of postural faint and 11 healthy subjects. Subjects were studied in the supine position and during upright tilt to 70°for 30 minutes and subgrouped into Sϩ, historical fainters who fainted during testing (nϭ24); SϪ, historical fainters who did not faint during testing (nϭ10); and control subjects. Supine venous occlusion plethysmography showed no differences between blood flows of the forearm and calf in Sϩ, SϪ, or control. Cardiac index, total peripheral resistance, and blood volume were not different. Using impedance plethysmography, we assessed blood redistribution during upright tilt. This demonstrated decreased thoracic blood volume and increased splanchnic, pelvic, and leg blood volumes for all subjects. However, thoracic blood volume was decreased in Sϩ compared with control volume, correlating well with the maximum upright heart rate. Splanchnic volume was decreased in the Sϩ and SϪ groups, correlating with the change in thoracic blood volume. Pelvic and leg volume changes were similar for all groups and uncorrelated to thoracic blood volume. Conclusions-Enhanced

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mentioning

confidence: 99%

Relation of Postural Vasovagal Syncope to Splanchnic Hypervolemia in Adolescents

Stewart

McLeod²,

Sanyal³

et al. 2004

Circulation

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“…Although an increase in HR by artificial pacing has been shown to increase cardiac output and improve clinical symptoms, 5,[8][9][10][11][12] the clinical experience of pacing therapy in vasovagal syncope remains controversial. 27 The present study demonstrated that patients with vasodepressor syncope had a higher cardiac output than patients with vasovagal syncope, and a positive correlation was found between HR and cardiac output during syncope.…”

Section: Discussionmentioning

confidence: 99%

“…Heart rate seems to play an important role in vasovagal syncope since anticholinergic agents [2][3][4][5][6][7] and pacemaker therapy 5,[8][9][10][11][12] have been shown to be effective in preventing recurrent symptoms. Increased vagal tone has been identified as a responsible factor in some patients with recurrent unexplained syncope.…”

Section: Introductionmentioning

confidence: 99%

“…14 On the other hand, HR was considered to play only a minor role in vasodepressor syncope because beta-adrenergic blocking drugs are found to be efficacious in treating patients with vasodepressor syncope. 5,6,15 It has been shown that vasovagal attacks could not be aborted by administration of atropine 15,16 or by artificial pacing. 16,17 Confronted with these diverse results, it appears appropriate to reassess the hemodynamic differences between patients who do and do not develop bradycardia during vasovagal/ vasodepressor syncope.…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic significance of heart rate in neurally mediated syncope

Chan

Wang

et al. 2004

Clinical Cardiology

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SummaryBackground: Vasovagal and vasodepressor syncope are used interchangeably in the literature to describe the common faint syndrome, now collectively named neurally mediated syncope. The significance of heart rate (HR) in these reflex-induced reactions remains unclear.Hypothesis: The study was undertaken to investigate the hemodynamic significance of HR in tilt-induced neurally mediated syncope.Methods: In all, 113 patients with syncope of unknown etiology were studied by head-up tilt test with invasive hemodynamic monitoring. Thirty-five patients (15 women, 20 men, age range 21 to 72 years) developed syncope and were enrolled for analysis. The hemodynamic data were compared between patients who developed bradycardia (vasovagal group, n = 15) and those without bradycardia (vasodepressor group, n = 20).Results: The baseline hemodynamic data (mean ± standard deviation) and the hemodynamic responses after 10-min headup tilt were similar between patients in the vasovagal and vasodepressor groups. During syncope, patients with vasovagal reaction developed hypotension and paradoxical bradycardia (HR = 52.4 ± 5.9 beats/min), while patients with vasodepressor reaction developed a precipitous drop in arterial blood pressure with inappropriate HR (105 ± 21 beats/min) compensation. Patients with vasovagal syncope manifested a significantly lower cardiac index and a significantly higher systemic

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“…ized cerebral hypoxia. Grubb et al 5) induced syncope with tonic-clonic seizure-like episodes in 67% of head-up tilt (HUT)-positive patients. They also reported 3 syncopal cases with convulsive activities for whom causes remained unknown even after extensive neurological and cardiovascular evaluations.…”

Section: Discussionmentioning

confidence: 99%

A Case of Loss of Consciousness due to Epilepsy Diagnosed Using an Implantable Loop Recorder

et al. 2011

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We report a case of clonic-tonic seizures diagnosed using an implantable loop recorder, a device for detecting cardiac arrhythmias. A 65-year-old man was referred to our hospital for loss of consciousness with myotonic jerks during sleep. He had experienced several similar episodes. No family history of sudden death was evident, and no structural heart disease was present. Coronary angiography with intracoronary acetylcholine (ACh) showed neither organic stenosis nor vasospastic angina. Ventricular tachyarrhythmias were not induced by programmed electrical stimuli. Sleep electroencephalography, brain magnetic resonance imaging and magnetic resonance angiography revealed no specific findings. We implanted a loop recorder to monitor rhythm abnormalities. One month later, an attack occurred at night. His wife recognized the episode and activated the implantable loop recorder. No arrhythmia was recorded, but myopotentials characteristic of tonic-clonic seizures were detected. (J Arrhythmia 2011; 27: 76-79)

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Differentiation of Convulsive Syncope and Epilepsy with Head-Up Tilt Testing

Abstract: Upright tilt table testing combined with isoproterenol infusion may be useful to distinguish convulsive syncope from epileptic seizures.

Cited by 145 publications

References 35 publications

Relation of Postural Vasovagal Syncope to Splanchnic Hypervolemia in Adolescents

Relation of Postural Vasovagal Syncope to Splanchnic Hypervolemia in Adolescents

Hemodynamic significance of heart rate in neurally mediated syncope

A Case of Loss of Consciousness due to Epilepsy Diagnosed Using an Implantable Loop Recorder

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