Clinical spectrum and prevalence of neurologic events provoked by tilt table testing

Rod Passman, George Horvath, Jay Thomas, Jane Kruse, Anand Shah, Jeffrey Goldberger, Alan Kadish

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Motor activity occurring during neurocardiogenic syncope can mimic true neurologic events. Objective: To assess the prevalence and type of apparent neurologic events associated with tilt table testing. Methods: The records of consecutive patients undergoing tilt table testing for the evaluation of syncope were reviewed. Patients underwent a 70° upright tilt for 40 minutes, followed by a 20-minute tilt while receiving isoproterenol hydrochloride. The results of tilt table tests were considered positive when clinical symptoms were reproduced in association with a decline in blood pressure. Clinical variables and neurologic events were analyzed. Results: Tilt table tests were performed on 694 patients during the study period, and the results were positive in 222 of them. Eighteen patients (8%) had apparent neurologic events during tilt table testing. Eleven patients (5%) had apparent tonic-clonic seizure-like activity, and 7 patients (3%) had non-tonic-clonic neurologic events, including focal seizures (n=3), dysarthria or aphasia (n=2), unilateral extremity dysesthesia (n=1), and reproduction of temporal lobe epilepsy symptoms (n=1). The patients with tonic-clonic seizure-like activity had a significantly lower systolic blood pressure reading at the termination of tilt table testing than all other patients whose tilt table test results were positive (P=.04). The heart rate at the time of test termination was significantly lower in the patients with tonic-clonic seizure-like activity and non-tonic-clonic neurologic events (P<.01) than in those with positive test results and no provoked neurologic events, and asystole was provoked more frequently in these 2 patient populations (P=.03). Conclusions: Neurologic events are common during episodes of neurocardiogenic syncope, and this diagnosis should be considered in the evaluation of unexplained seizurelike activity.

Original languageEnglish (US)
Pages (from-to)1945-1948
Number of pages4
JournalArchives of Internal Medicine
Volume163
Issue number16
DOIs
StatePublished - Sep 8 2003
Externally publishedYes

Fingerprint

Nervous System
Tilt-Table Test
Seizures
Vasovagal Syncope
Blood Pressure
Dysarthria
Temporal Lobe Epilepsy
Paresthesia
Aphasia
Syncope
Heart Arrest
Isoproterenol
Reproduction
Reading
Motor Activity
Extremities
Heart Rate

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Clinical spectrum and prevalence of neurologic events provoked by tilt table testing. / Passman, Rod; Horvath, George; Thomas, Jay; Kruse, Jane; Shah, Anand; Goldberger, Jeffrey; Kadish, Alan.

In: Archives of Internal Medicine, Vol. 163, No. 16, 08.09.2003, p. 1945-1948.

Research output: Contribution to journalArticle

Passman, Rod ; Horvath, George ; Thomas, Jay ; Kruse, Jane ; Shah, Anand ; Goldberger, Jeffrey ; Kadish, Alan. / Clinical spectrum and prevalence of neurologic events provoked by tilt table testing. In: Archives of Internal Medicine. 2003 ; Vol. 163, No. 16. pp. 1945-1948.
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abstract = "Background: Motor activity occurring during neurocardiogenic syncope can mimic true neurologic events. Objective: To assess the prevalence and type of apparent neurologic events associated with tilt table testing. Methods: The records of consecutive patients undergoing tilt table testing for the evaluation of syncope were reviewed. Patients underwent a 70° upright tilt for 40 minutes, followed by a 20-minute tilt while receiving isoproterenol hydrochloride. The results of tilt table tests were considered positive when clinical symptoms were reproduced in association with a decline in blood pressure. Clinical variables and neurologic events were analyzed. Results: Tilt table tests were performed on 694 patients during the study period, and the results were positive in 222 of them. Eighteen patients (8{\%}) had apparent neurologic events during tilt table testing. Eleven patients (5{\%}) had apparent tonic-clonic seizure-like activity, and 7 patients (3{\%}) had non-tonic-clonic neurologic events, including focal seizures (n=3), dysarthria or aphasia (n=2), unilateral extremity dysesthesia (n=1), and reproduction of temporal lobe epilepsy symptoms (n=1). The patients with tonic-clonic seizure-like activity had a significantly lower systolic blood pressure reading at the termination of tilt table testing than all other patients whose tilt table test results were positive (P=.04). The heart rate at the time of test termination was significantly lower in the patients with tonic-clonic seizure-like activity and non-tonic-clonic neurologic events (P<.01) than in those with positive test results and no provoked neurologic events, and asystole was provoked more frequently in these 2 patient populations (P=.03). Conclusions: Neurologic events are common during episodes of neurocardiogenic syncope, and this diagnosis should be considered in the evaluation of unexplained seizurelike activity.",
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AB - Background: Motor activity occurring during neurocardiogenic syncope can mimic true neurologic events. Objective: To assess the prevalence and type of apparent neurologic events associated with tilt table testing. Methods: The records of consecutive patients undergoing tilt table testing for the evaluation of syncope were reviewed. Patients underwent a 70° upright tilt for 40 minutes, followed by a 20-minute tilt while receiving isoproterenol hydrochloride. The results of tilt table tests were considered positive when clinical symptoms were reproduced in association with a decline in blood pressure. Clinical variables and neurologic events were analyzed. Results: Tilt table tests were performed on 694 patients during the study period, and the results were positive in 222 of them. Eighteen patients (8%) had apparent neurologic events during tilt table testing. Eleven patients (5%) had apparent tonic-clonic seizure-like activity, and 7 patients (3%) had non-tonic-clonic neurologic events, including focal seizures (n=3), dysarthria or aphasia (n=2), unilateral extremity dysesthesia (n=1), and reproduction of temporal lobe epilepsy symptoms (n=1). The patients with tonic-clonic seizure-like activity had a significantly lower systolic blood pressure reading at the termination of tilt table testing than all other patients whose tilt table test results were positive (P=.04). The heart rate at the time of test termination was significantly lower in the patients with tonic-clonic seizure-like activity and non-tonic-clonic neurologic events (P<.01) than in those with positive test results and no provoked neurologic events, and asystole was provoked more frequently in these 2 patient populations (P=.03). Conclusions: Neurologic events are common during episodes of neurocardiogenic syncope, and this diagnosis should be considered in the evaluation of unexplained seizurelike activity.

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