Differentiation of convulsive syncope and epilepsy with head-up tilt testing

Article Abstract:

Syncope is a transient loss of consciousness which results from a momentary deficiency in the blood flow to the brain. One of the many ways in which the blood flow to the brain may become temporarily inadequate is an abnormal physiological response to changes in posture. Syncope resulting from abnormal postural responses is sometimes called vasovagal syncope, because it is mediated by the vascular system and the tenth cranial nerve, the vagus. In some cases, the low blood pressure and slow heart beat resulting from a postural change may result in convulsive seizures. Convulsive seizures are common, and it is estimated that 3 percent of the US population has recurrent unprovoked seizures. It is clearly important to distinguish between seizures which result from epilepsy or other causes and those resulting from syncope. A study was done to determine if tilt table testing might prove useful in identifying convulsive syncope and distinguishing it from epilepsy. In this test, the patient is monitored for physiological responses while on a table which may be tilted to varying angles. This permits the patient's balance system and blood pressure demands to be altered without the patient himself moving. This method was used in the evaluation of eight men and seven women with a history of recurrent seizures which have proved unresponsive to antiepileptic medication. None of the patients had abnormal electroencephalogram (EEG) recordings. A total of 16 episodes of convulsions were elicited from 10 patient on the tilt table. In four patients, the convulsions were elicited by tilting only after administration of the heart drug isoproterenol. In two patients, momentary cessation of the heartbeat was observed. A significant observation in the present study was that the convulsions occurred almost simultaneously with the syncope, in contrast with the belief of some that convulsions would begin later, only as the brain used up its oxygen. The patients whose seizures appeared to be due to vasovagal syncope, based on this test, were placed on beta blocker drugs (two eventually received pacemakers); after an average of 21 months of follow-up, these patients have remained free of seizures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Physiological aspects, Epilepsy, Convulsions, Seizures (Medicine), Tilt table

---

Cardiac pacing for prevention of recurrent vasovagal syncope

Article Abstract:

Cardiac pacing may be useful in preventing vasovagal syncope in a limited number of patients. Vasovagal syncope is a fainting spell marked by bradycardia (slowed heart beat) and hypotension (fall in blood pressure). Cardiac pacing involves regulating the heart beat with an implanted pacemaker. Tilt table testing is used to diagnose patients with recurrent vasovagal syncope and to evaluate the physiologic responses involved. Because of the variability of these responses, an effective treatment may not apply to all patients. Researchers analyzed eight studies reported in the medical literature and found differing results. If the syncope response is due mainly to a heart-inhibiting mechanism, cardiac pacing appears to be an effective treatment for some patients. However, long-term studies are needed, as well as research on appropriate pacing algorithms.

Evaluation, Prevention

---

Termination of implantable pacemaker therapy: experience in five patients

Article Abstract:

Some patients may not need pacemakers for their entire lives. Permanent pacemakers were removed from five patients whose rhythmic disturbances seemed to have improved or been reversed. No patient experienced a slowing heart rate during the 18 to 48 months after removing the pacemakers. These patients had initially been recommended for a pacemaker either because of an abnormally slow heart rate or a block in the conducting impulse within the heart.

Pacemaker, Artificial (Heart), Pacemakers

Similar abstracts:

• Abstracts: Expression of cyclooxygenase types 1 and 2 in human fetal membranes at term. The incidence of uniparental disomy associated with intrauterine growth retardation in a cohort of thirty-five severely affected babies
• Abstracts: Ergonomics: show 'good faith.' Get in step with the right footwear. Hearing protection: no noise is good news
• Abstracts: Comeback kid: how to safely return to the gym, and get real results, when you're starting over. Smart circuit training

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.