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Seizures pp 271–283Cite as

Seizures and Syncope

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Part of the book series: Current Clinical Neurology ((CCP))

Abstract

Syncope, defined as an abrupt loss of consciousness and postural tone caused by cerebral hypoperfusion with spontaneous recovery, is a common clinical problem, accounting for 3% of emergency room visits and 6% of general hospital admissions in the United States (1). A subset of these patients (up to 12%) have an associated convulsive reaction, which may be difficult to differentiate from epilepsy (2). This entity has been designated convulsive syncope. It is estimated that as many as 20–30% of patients diagnosed with epilepsy may in fact suffer from convulsive syncope (3,4). The intent of this chapter is to review the approach to the patient with syncope, with an emphasis toward differentiating syncope from seizures.

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References

  1. Benditt DG, Remole S, Milstein S, Bailin S. Syncope: Causes, clinical evaluation, and current therapy. Annu Rev Med 1992; 43: 283–300.

    Article  PubMed  CAS  Google Scholar 

  2. Lin JT-Y, Ziegler DK, Lai C-W, Bayer W. Convulsive syncope in blood donors. Ann Neurol 1982; 11: 525–528.

    Article  PubMed  CAS  Google Scholar 

  3. Silbert PL, Graydon RH, Stewart-Wynne EG. Convulsive syncope and the diagnosis of a first epileptic seizure. Med J Austral 1992; 157: 72.

    PubMed  CAS  Google Scholar 

  4. Zaidi A, Crampton S, Clough P, Scheepers B, Fitzpatrick AP. Misdiagnosis of epilepsy-Many seizure-like episodes have a cardiovascular cause. PACE 1999; 22: 457A.

    Google Scholar 

  5. Dohrmann ML, Cheitlin MD. Cardiogenic syncope: seizures versus syncope. Neurol Clin 1986; 4: 549–562.

    PubMed  CAS  Google Scholar 

  6. Brooks R, Ruskin JN. Evaluation of the patient with unexplained syncope. In Zipes DP, Jalife J (eds.), Cardiac Electrophysiology: From Cell to Bedside. Philadelphia, PA: WB Saunders, 1995.

    Google Scholar 

  7. Mark AL. The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol 1983; 1: 90–102.

    Article  PubMed  CAS  Google Scholar 

  8. Benditt DG, Lurie KG, Fabian WH. Clinical approach to diagnosis of syncope. Cardiol Clin 1997; 15: 165–176.

    Article  PubMed  CAS  Google Scholar 

  9. Benditt DG, Sakaguchi S, Goldstein MA, Lurie KG, Gornick CC, Adler SW. Sinus node dysfunction: pathophysiology, clinical features, evaluation, and treatment. In Zipes DP, Jalife J (eds.), Cardiac Electrophysiology: From Cell to Bedside. Philadelphia, PA: WB Saunders, 1995.

    Google Scholar 

  10. Leitch JW, Klein GJ, Yee R, Leather RA, Kim YH. Syncope associated with supraventricular tachycardia: An expression of tachycardia rate or vasomotor response? Circulation 1992; 85: 1064–1071.

    Article  PubMed  CAS  Google Scholar 

  11. Sundaram MBM, McMeekin JD, Gulamhusein S. Cardiac tachyarrhythmias in hereditary long QT syndromes presenting as a seizure disorder. Can J Neurol Sci 1986; 13: 262–263.

    PubMed  CAS  Google Scholar 

  12. Davis AM, Wilkinson JL. The long QT syndrome and seizures in childhood. J Paediatr Child Health 1998; 34: 410–411.

    Article  PubMed  CAS  Google Scholar 

  13. Linzer M, Varia I, Pontinen M, Divine GW, Grubb BP, Estes NAM III. Medically unexplained syncope: relationship to psychiatric illness. Am J Med 1992; 92: 1A - 18A.

    Article  Google Scholar 

  14. Reeves AL, Nollet KE, Klass DW, Sharbrough FW, SO EL. The ictal bradycardia syndrome. Epilepsia 1996; 137: 983–987.

    Article  Google Scholar 

  15. Constantin L, Martins JB, Fincham RW, Dagli RD. Bradycardia and syncope as manifestations of partial epilepsy. J Am Coll Cardiol 1990; 15: 900–905.

    Article  PubMed  CAS  Google Scholar 

  16. Bergey GK, Krumholz A, Fleming CP. Complex partial seizure provocation by vaso-vagal syncope: video-EEG and intracranial electrode documentation. Epilepsia 1997; 38: 118–121.

    Article  PubMed  CAS  Google Scholar 

  17. Tanaka T, Inoue H, Aizawa H, et al. Case of cough syncope with seizure. Respiration 1994; 61: 48–50.

    Article  PubMed  CAS  Google Scholar 

  18. Locatelli ER, Varghese JP, Shuaib A, Potolicchio SJ. Cardiac asystole and bradycardia as a manifestation of left temporal lobe complex partial seizure. Ann Intern Med 1999; 130: 581–583.

    PubMed  CAS  Google Scholar 

  19. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC. Cardiovascular effects of human insular cortex stimulation. Neurology 1992; 42: 1727–1732.

    Article  PubMed  CAS  Google Scholar 

  20. Hoefnagels WAJ, Padberg GW, Overweg J, Roos RAC. Syncope or seizure? A matter of opinion. Clin Neurol Neurosurg 1992; 94: 153–156.

    Article  PubMed  CAS  Google Scholar 

  21. Hoefnagels WAJ, Padberg GW, Overweg J, van der Velde EA, Roos RAC. Transient loss of consciousness: the value of the history for distinguishing seizure from syncope. JNeurol 1991; 238: 39–43.

    CAS  Google Scholar 

  22. Krahn AD, Klein GJ, Yee R, Takle-Newhouse T, Norris C. Use of an extended monitoring strategy in patients with problematic syncope. Circulation 1999; 99: 406–410.

    Article  PubMed  CAS  Google Scholar 

  23. Beauregard LAM, Fabiszewski R, Black CH, et al. Combined ambulatory electroencephalographic and electrocardiographic recordings for evaluation of syncope. Am J Cardiol 1991; 68: 1067–1072.

    Article  PubMed  CAS  Google Scholar 

  24. Brenner RP. Electroencephalography in syncope. J Clin Neurophysiol 1997; 14: 197–209.

    Article  PubMed  CAS  Google Scholar 

  25. Gastaut H, Fischer-Williams M. Electro-encephalographic study of syncope: its differentiation from epilepsy. Lancet 1957; 2: 1018–1025.

    Article  Google Scholar 

  26. Kempster PA, Balla JI. A clinical study of convulsive syncope. Clin Exp Neurol 1986; 22: 53–55.

    PubMed  CAS  Google Scholar 

  27. Aminoff MJ, Scheinman MM, Griffin JC, Herre JM. Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias Ann Internal Med 1988; 108: 791–796.

    CAS  Google Scholar 

  28. Sheldon RS, Koshman ML, Murphy WE Electroencephalographic findings during presyncope and syncope induced by tilt table testing. Can J Cardiol 1998; 14: 811–816.

    PubMed  CAS  Google Scholar 

  29. Kenny RA, Bayliss J, Ingram A, Sutton, R. Head-up tilt: a useful test for investigating unexplained syncope. Lancet 1986; 1: 1352–1354.

    Article  PubMed  CAS  Google Scholar 

  30. Benditt DG, Remole S, Bailin S, Dunnigan A, Asso A, Milstein S. Tilt table testing for evaluation of neurally-mediated (cardioneurogenic) syncope: rationale and proposed protocols. PACE 1991; 14: 1528–1537.

    Article  PubMed  CAS  Google Scholar 

  31. Benditt DG, Ferguson DW, Grubb BP, et al. Tilt table testing for assessing syncope. J Am Coll Cardiol 1996; 28: 263–275.

    Article  PubMed  CAS  Google Scholar 

  32. Grubb BP, Gerard G, Roush K, Temesy-Armos P, Elliott L, Hahn H, Spann C. Differentiation of convulsive syncope and epilepsy with head-up tilt testing. Ann Internal Med 1991: 115: 871–876.

    CAS  Google Scholar 

  33. Almquist A, Goldenberg I, Milstein S, et al. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med 1989; 320: 346–351.

    Article  PubMed  CAS  Google Scholar 

  34. Mittal S, Stein KM, Markowitz SM, Slotwiner DJ, Rohatgi S, Lerman BB. Induction of neurally mediated syncope with adenosine. Circulation 1999; 99: 1318–1324.

    Article  PubMed  CAS  Google Scholar 

  35. Biaggioni I, Olafsson B, Robertson RM, Hollister AS, Robertson D. Cardiovascular and respiratory effects of adenosine in conscious man. Evidence for chemoreceptor activation. Circ Res 1987; 61: 779–786.

    Article  PubMed  CAS  Google Scholar 

  36. Biaggiono I, Killian TJ, Mosqueda-Garcia R, Robertson RM, Robertson D. Adenosine increases sympathetic nerve traffic in humans. Circulation 1991; 83: 1668–1675.

    Article  Google Scholar 

  37. Engelstein ED, Lerman BB, Somers VK, Rea RF. Role of arterial chemoreceptors in mediating the effects of endogenous adenosine on sympathetic nerve activity. Circulation 1994; 90: 2919–2926.

    Article  PubMed  CAS  Google Scholar 

  38. Neufeld MY, Treves TA, Chistik V, Korczyn AD. Sequential serum creatine kinase determination differentiates vaso-vagal syncope from generalized tonic-clonic seizures. Acta Neurol Scand 1997: 95: 137–139.

    Article  PubMed  CAS  Google Scholar 

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Mittal, S., Lerman, B.B. (2002). Seizures and Syncope. In: Delanty, N. (eds) Seizures. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-094-0_17

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  • DOI: https://doi.org/10.1007/978-1-59259-094-0_17

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-207-0

  • Online ISBN: 978-1-59259-094-0

  • eBook Packages: Springer Book Archive

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