Seizure-Like Activities during Head-Up Tilt Test- Induced Syncope

다국어 초록 (Multilingual Abstract)

Purpose: Some patients with neurally mediated reflex syncope may be misdiagnosed as epilepsy because myoclonic jerky movements are observed during syncope. The seizure-like activities during the head-up tilt test (HUT) have been rarely reported. The purpose of this study was to assess the characteristics of these seizure-like activities and evaluate whether there are differences in the clinical characteristics and hemodynamic parameters of patients with neurally mediated reflex syncope with and without seizure-like activities during HUT-induced syncope. Materials and Methods: The medical records of 1,383 consecutive patients with a positive HUT were retrospectively reviewed, and 226 patients were included in this study. Results: Of 226 patients, 13 (5.75%) showed seizure-like activities, with 5 of these (2.21%) having multifocal myoclonic jerky movements, 5 (2.21%) having focal seizurelike activity involving one extremity, and 3 (1.33%) having upward deviation of eye ball. Comparison of patients with and without seizure-like activities revealed no significant differences in terms of clinical variables and hemodynamic parameters during HUT. Conclusion: Seizure-like activities occurred occasionally during HUTinduced syncope in patients with neurally mediated reflex syncope. The seizure-like activities during HUT might not be related to the severity of the syncopal episodes or hemodynamic changes during HUT.

참고문헌 (Reference)

1 Lempert T, "Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia" 36 : 233-237, 1994

2 Grubb BP, "Pathophysiology and differential diagnosis of neurocardiogenic syncope" 84 : 3Q-9Q, 1999

3 Fejerman N, "Nonepileptic disorders imitating generalized idiopathic epilepsies" 46 : 80-83, 2005

4 Brignole M, "New classification of hemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the presyncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study" 2 : 66-76, 2000

5 Zaidi A, "Misdiagosis of epilepsy: many seizure-like attacks have a cardiovascular cause" 36 : 181-184, 2000

6 Sheldon R, "Historical criteria that distinguish syncope from seizures" 40 : 142-148, 2002

7 Kim PH, "Frequency of arrhythmic events during head-up tilt testing in patients with suspected neurocardiogenic syncope or presyncope" 94 : 1491-1495, 2004

8 Ammirati F, "Electroencephalographic correlates of vasovagal syncope induced by head-up tilt testing" 29 : 2347-2351, 1998

9 Grubb BP, "Differentiation of convulsive syncope and epilepsy with head-up tilt testing" 115 : 871-876, 1991

10 Lin JT, "Convulsive syncope in blood donors" 11 : 525-528, 1982

11 Passman R, "Clinical spectrum and prevalence of neurologic events provoked by tilt table testing" 163 : 1945-1948, 2003

12 Carey BJ, "Cerebral autoregulatory responses to head-up tilt in normal subjects and patients with recurrent vasovagal syncope" 104 : 898-902, 2001

13 Paulson OB, "Cerebral autoregulation" 2 : 161-192, 1990

14 Brignole M, "Carotid sinus massage, eyeball compression, and headup tilt test in patients with syncope of uncertain origin and in healthy control subjects" 122 : 1644-1651, 1991

15 Stern S, "Atrial and ventricular asystole for 19 seconds without syncope. Report of a case" 12 : 28-33, 1976