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Seizure-Like Activities during Head-Up Tilt Test- Induced Syncope
송필상,박정외,임혜란,허준,김준형,온영근,김준수 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.1
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.
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김준수,천광진,임혜란,박정외,박승정,박경민,온영근 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.2
Purpose: An association between baroreflex sensitivity (BRS) and the response to tilt training has not been reported in patientswith neurally mediated syncope (NMS). This study sought to investigate the role of BRS in predicting the response to tilt trainingin patients with NMS. Materials and Methods: We analyzed 57 patients who underwent tilt training at our hospital. A responder to tilt training was definedas a patient with three consecutive negative responses to the head-up tilt test (HUT) during tilt training. Results: After tilt training, 52 patients (91.2%) achieved three consecutive negative responses to the HUT. In the supine positionbefore upright posture during the first session of tilt training for responders and non-responders, the mean BRS was 18.17±10.09ms/mm Hg and 7.99±5.84 ms/mm Hg (p=0.008), respectively, and the frequency of BRS ≥8.945 ms/mm Hg was 45 (86.5%) and 1(20.0%; p=0.004), respectively. Age, male gender, frequency of syncopal events before HUT, type of NMS, phase of positive HUT, totalnumber of tilt training sessions, and mean time of tilt training did not differ between the study groups. In the multivariate analysis,BRS <8.945 ms/mm Hg in the supine position (odds ratio 23.10; 95% CI 1.20–443.59; p=0.037) was significantly and independentlyassociated with non-response to tilt training. Conclusion: The BRS value in the supine position could be a predictor for determining the response to tilt training in patientswith NMS who are being considered for inpatient tilt training.
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