Seizure-like activities in patients with head-up tilt test-induced syncope

Abstract

The purpose of this study was to assess the prevalence and the characteristics of seizure-like activities during head-up tilt test (HUT)-induced syncope, in patients with suspected vasovagal syncope (VVS). We also evaluated the differences in hemodynamic parameters between patients with and without seizure-like activities.A total of 71 patients with suspected VVS, who showed syncope during HUT between October 2010 and May 2013, were analyzed. Electrocardiogram and hemodynamic parameters were continuously monitored during HUT. We also performed video recording of patients during HUT to identify eyeball deviation or seizure-like limb movements.In all, 47 patients (66.2%) showed seizure-like activities at the time of syncope during HUT, 14 patients presented eyeball deviation, without abnormal limb movements, and 33 patients showed abnormal limb movements, such as myoclonic or tonic-clonic activities, as well as eyeball deviation. Upon comparison of the 2 groups with or without seizure-like activities, patients showing seizure-like activities presented a significantly lower heart rate at the time of syncope in HUT (38.51 ± 16.81 vs 49.67 ± 20.12, P < .05). Also, upon comparison within patients showing seizure-like activities, the patients who showed abnormal limb movements with eyeball deviation demonstrated a significantly lower systolic blood pressure and cardiac output at the time of syncope (34.30 ± 12.24 vs 49.00 ± 14.14, P < .05; 0.58 ± 0.40 vs 1.32 ± 0.97, P < .05).Seizure-like activities were observed in high percentage in about 66% of patients during HUT-induced syncope. The occurrence of seizure-like activities was associated with more severe transient hemodynamic changes, such as lower heart rate, systolic blood pressure, and cardiac output at the time of the HUT-induced syncope.

Risk Factors and Prognostic Follow-Up of Vasovagal Syncope Children With Seizure-Like Activities During Head-Up Tilt Test Induced-Syncope

“…Patients with VVS may present myoclonic jerky movements or upward deviation of eyeball during syncopal episodes and be misdiagnosed as epilepsy (5,6). Besides, reports showed that 8 to 66% of patients with neurally mediated syncope experienced seizurelike activities at the time of syncope during HUTT (7,8). The hemodynamic parameters related to seizure-like activities during HUTT-induced syncope in adults were reported in the previous study (7).…”

“…Passman et al demonstrated that patients with seizure-like activities had significantly lower systolic BP and HR, and more frequent asystole at the time of syncope during HUTT than those without seizure-like activities (8). In another study, patients with seizure-like activities during HUTT had a lower HR and more occurrence of asystole at the time of syncope (7). In our study, VVS children with seizurelike activities showed a lower HR at the time of syncope, but no significant difference in systolic BP was found between patients with or without seizure-like activities.…”

“…Besides, reports showed that 8 to 66% of patients with neurally mediated syncope experienced seizurelike activities at the time of syncope during HUTT (7,8). The hemodynamic parameters related to seizure-like activities during HUTT-induced syncope in adults were reported in the previous study (7). However, there is no relevant study in children and the prognosis of VVS children with seizure-like activities during HUTT-induced syncope has not been revealed.…”

Seizure-like presentation in OHCA creates barriers to dispatch recognition of cardiac arrest

“…Seizure-like activity was associated with low systolic blood pressures and bradycardia during head-up tilt test (HUT)-induced syncope in a study by Joo et al They found 47 of 71 (66.2%) patients undergoing HUT had some sort of seizure-like activity, including eye deviation and jerking movements, with 70.2% of those 47 patients showing both. 19 Sudden cardiac arrest is physiologically similar to (HUT)-induced syncope, with the primary problem being a sudden loss of brain perfusion. The short duration of seizure-like activity due to loss of perfusion to the brain or sudden asphyxia seems to be a distinction repeated in the literature.…”

Heart rate variability and systemic hemodynamic state in adults with a first time, non-traumatic epileptic seizure during an orthoclinostatic stress test

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