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Gunaga S, Smythe D, Shearer N, Hashem M, Al‐Hage A. Man with convulsive syncope. J Am Coll Emerg Physicians Open 2024; 5:e13249. [PMID: 39104917 PMCID: PMC11299247 DOI: 10.1002/emp2.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024] Open
Affiliation(s)
- Satheesh Gunaga
- Department of Emergency Medicine and Graduate Medical EducationHenry Ford Wyandotte HospitalWyandotteMichiganUSA
- Department of Emergency MedicineEnvision HealthcareAnn ArborMichiganUSA
- Department of Osteopathic Medical SpecialtiesMichigan State University College of Osteopathic MedicineEast LansingMichiganUSA
| | - Dennis Smythe
- Department of Emergency Medicine and Graduate Medical EducationHenry Ford Wyandotte HospitalWyandotteMichiganUSA
- Department of Osteopathic Medical SpecialtiesMichigan State University College of Osteopathic MedicineEast LansingMichiganUSA
| | - Nathaniel Shearer
- Department of Emergency Medicine and Graduate Medical EducationHenry Ford Wyandotte HospitalWyandotteMichiganUSA
- Department of Osteopathic Medical SpecialtiesMichigan State University College of Osteopathic MedicineEast LansingMichiganUSA
| | - Mustafa Hashem
- Department of Internal MedicineDivision of CardiologyHenry Ford Wyandotte HospitalWyandotteMichiganUSA
| | - Abe Al‐Hage
- Department of Emergency Medicine and Graduate Medical EducationHenry Ford Wyandotte HospitalWyandotteMichiganUSA
- Department of Emergency MedicineEnvision HealthcareAnn ArborMichiganUSA
- Department of Osteopathic Medical SpecialtiesMichigan State University College of Osteopathic MedicineEast LansingMichiganUSA
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Kokorelis C, Rowe PC. Seizure Versus Convulsive Syncope: A Case Report. Clin Pediatr (Phila) 2024:99228241253902. [PMID: 38742456 DOI: 10.1177/00099228241253902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Christina Kokorelis
- Johns Hopkins University, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
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3
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Rentiya ZS, Palle LRA, Emmanuel S, Shah H, Adegbite A, Chu Carredo CK, Blanco Montecino RM, Asfeen UZ, Hussain A, Akuma O, Khan AM, Kelechi AE. Management of an undetectable Diverticular Bleed: A Case Report and Literature review. Clin Case Rep 2024; 12:e8588. [PMID: 38523824 PMCID: PMC10957488 DOI: 10.1002/ccr3.8588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Diverticular bleeding is the most common cause of lower gastrointestinal bleeding and accounts for 20.8%-41.6% of cases in the Western world. Management involves initial resuscitation followed by diagnostic assessment. Colonoscopy is the investigation of choice as it localizes the bleed and has the potential to effectively deliver therapeutic interventions. Other diagnostic modalities include flexible sigmoidoscopy, a tagged red blood cell scan, or angiography. In cases where the bleeding source cannot be identified, intraoperative enteroscopy has emerged as a valuable tool for investigating obscure gastroenterology bleeds in specific patients. In this case report, we describe the management of a 77-year-old male with recently diagnosed pan-colonic diverticulosis who presented with multiple episodes of rectal bleeding and syncope. Due to his declining hemodynamic status and failed endoscopy and embolization, he was taken to surgery for a colectomy. Intraoperative colonoscopy was utilized to facilitate accurate identification of the pathology, assessment of anastomotic patency, and detection of surgical complications. This case report attempts to portray how the incorporation of endo-videoscopy into surgical planning has the potential to enhance patient outcomes and represent a significant advancement in the field of minimally invasive surgery.
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Affiliation(s)
- Zubir S. Rentiya
- Department of Radiation Oncology & RadiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
- Department of SurgeryMedStar Georgetown UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Sanni Emmanuel
- Department of SurgeryNational Hospital AbujaAbujaNigeria
| | - Heeya Shah
- Medical University of South CarolinaLancasterPennsylvaniaUSA
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Asada S, Morita H, Mizuno T, Masuda T, Ueoka A, Miyamoto M, Kawada S, Nakagawa K, Nishii N. Syncope and loss of consciousness after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: Prevalence and characteristics in long-term follow-up. Heart Rhythm O2 2023; 4:641-649. [PMID: 37936673 PMCID: PMC10626187 DOI: 10.1016/j.hroo.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Syncope is a significant prognostic factor in patients with Brugada syndrome (BrS). However, the risk of ventricular arrhythmia in patients with nonarrhythmic loss of consciousness (LOC) is similar to that in asymptomatic patients. LOC events after implantable cardioverter-defibrillator (ICD) implantation may provide insights into underlying causes of the initial LOC episode. Objective The purpose of this study was to examine LOC characteristics following ICD implantation. Methods We retrospectively analyzed 112 patients with BrS (mean age 47 years; 111 men) who were treated with an ICD. The patients were classified into 3 groups based on symptoms at implantation: asymptomatic (35 patients); LOC (46 patients); and ventricular tachyarrhythmia (VTA) (31 patients). We evaluated the incidence and cause of LOC during long-term follow-up after ICD implantation. Results During mean follow-up of 12.2 years, 41 patients (37%) experienced LOC after ICD implantation. Arrhythmic LOC occurred in 5 asymptomatic patients, 14 LOC patients, and 16 patients with VTA. Nonarrhythmic LOC, similar to the initial episode, occurred after ICD implantation in 6 patients with prior LOC (2 with neurally mediated syncope and 4 with epilepsy). Most epileptic patients experienced LOC during rest or sleeping, and did not show an abnormal encephalogram during initial evaluation of the LOC episodes. Conclusion After ICD implantation, 13% of patients had nonarrhythmic LOC similar to the initial episode. Accurate classification of LOC based on a detailed medical history is important for risk stratification, although distinguishing arrhythmic LOC from epilepsy-related LOC episodes can be challenging depending on the circumstances and characteristics of the LOC event.
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Affiliation(s)
- Saori Asada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomofumi Mizuno
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuro Masuda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akira Ueoka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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5
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Francisco Pascual J, Jordan Marchite P, Rodríguez Silva J, Rivas Gándara N. Arrhythmic syncope: From diagnosis to management. World J Cardiol 2023; 15:119-141. [PMID: 37124975 PMCID: PMC10130893 DOI: 10.4330/wjc.v15.i4.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.
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Affiliation(s)
- Jaume Francisco Pascual
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- Grup de Recerca Cardiovascular, Vall d’Hebron Institut de Recerca, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Pablo Jordan Marchite
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Jesús Rodríguez Silva
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Nuria Rivas Gándara
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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6
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Perez DL, Hoch DB, Cohen JN. Case 10-2023: A 27-Year-Old Man with Convulsions. N Engl J Med 2023; 388:1210-1218. [PMID: 36988597 DOI: 10.1056/nejmcpc2211365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- David L Perez
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
| | - Daniel B Hoch
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
| | - Jonah N Cohen
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
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7
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Chokote E, Ngarka L, Takoeta EO, Kengni HNT, Nfor LN, Mengnjo MK, Mendo EL, Djeutcheu F, Yepnjio FN, Tatah GY, Mbassi HDA, Njamnshi AK. A rare case of drug sensitive adult‐onset temporal lobe epilepsy due to a focal cortical dysplasia revealed by ictal coughing: First report in sub‐Saharan Africa. Clin Case Rep 2023; 11:e7093. [PMID: 36992669 PMCID: PMC10041363 DOI: 10.1002/ccr3.7093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/30/2022] [Accepted: 02/25/2023] [Indexed: 03/30/2023] Open
Abstract
This case suggests that clinicians should consider seizures as a differential diagnosis of paroxystic cough with loss of consciousness. Focal cortical dysplasia should equally be screened for with magnetic resonance imaging (MRI) scans even in adults with epilepsy in sub‐Saharan Africa. This case suggests that clinicians should consider seizures as a differential diagnosis of paroxystic cough with loss of consciousness. Focal cortical dysplasia should equally be screened for with Magnetic Resonance Imaging (MRI) scans even in adults with epilepsy in sub‐Saharan Africa.
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Affiliation(s)
- Eric‐Samuel Chokote
- Department of NeurologyJordan Medical ServicesYaoundéCameroon
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
| | - Leonard Ngarka
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
| | | | - Hermann Nestor Tsague Kengni
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
- Department of CardiologyJordan Medical ServicesYaoundéCameroon
| | - Leonard N. Nfor
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
| | - Michel K. Mengnjo
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
| | - Edwige Laure Mendo
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of NeurologyEbolowa Regional HospitalEbolowaCameroon
| | | | | | - Godwin Y. Tatah
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
- Department of NeurologyCH Saint‐NazaireSaint‐NazaireFrance
| | - Hubert Désiré Awa Mbassi
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
- Chantal Biya FoundationMCCYaoundéCameroon
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN)YaoundéCameroon
- Brain Research Africa Initiative (BRAIN)GenevaSwitzerland
- Department of Neurology Yaoundé Central HospitalYaoundéCameroon
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
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8
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Mikellides G, Michael P, Schuhmann T, Sack AT. TMS-Induced Seizure during FDA-Approved Bilateral DMPFC Protocol for Treating OCD: A Case Report. Case Rep Neurol 2021; 13:584-590. [PMID: 34703446 PMCID: PMC8460881 DOI: 10.1159/000518999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/05/2021] [Indexed: 12/02/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation therapy that has become a method of choice for the treatment of several neuropsychiatric disorders such as depression and OCD. It is considered to be a safe and well-tolerated treatment, with only few side effects. The most serious adverse event during any rTMS treatment is the potential induction of a seizure. rTMS has shown very encouraging results for treatment-resistant OCD, although the optimal target area and the stimulation frequency are still matters of controversy. Here, we present a 19-year-old female patient with OCD who experienced seizure during the 7th session of her rTMS treatment using the FDA-approved 20-Hz protocol for OCD applied bilaterally over the left and right DMPFC using a double-cone coil. Nonetheless, it still unknown whether the seizure occurred as a consequence of rTMS, as the patient was also in a specific seizure risk group. Future reviews are needed to further clarify the mechanisms that may trigger seizures during rTMS treatments in order to reduce the likelihood of rTMS-induced seizures.
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Affiliation(s)
- Georgios Mikellides
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Cyprus rTMS Centre, Larnaca, Cyprus
| | | | - Teresa Schuhmann
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Alexander T Sack
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
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9
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Maita H, Kobayashi T, Akimoto T, Osawa H, Kato H. A case of juvenile myoclonic epilepsy in which a disease‐specific question led to the diagnosis. J Gen Fam Med 2021; 23:107-109. [PMID: 35261859 PMCID: PMC8888799 DOI: 10.1002/jgf2.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
A 17‐year‐old female patient presented to our hospital with repeated transient loss of consciousness lasting less than 10 min. After regaining consciousness, she experienced no disorientation, confusion, tongue‐biting, or incontinence. Physical findings, blood tests, electrocardiogram, and echocardiogram showed no obvious abnormalities. On being asked whether she had experienced sudden rapid body movements, she answered “yes.” Therefore, we suspected juvenile myoclonic epilepsy (JME) and obtained an electroencephalogram, which showed diffuse bilateral bursts of spike‐and‐wave complexes, confirming the diagnosis. In adolescent patients with transient loss of consciousness, myoclonic jerks should be actively confirmed for the diagnosis of JME.
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Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Aomori Japan
| | - Tadashi Kobayashi
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Takashi Akimoto
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Hiroshi Osawa
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
| | - Hiroyuki Kato
- Development of Community Healthcare Hirosaki University Graduate School of Medicine Aomori Japan
- Department of General Medicine Hirosaki University School of Medicine & Hospital Aomori Japan
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10
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A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit. ACTA ACUST UNITED AC 2021; 57:medicina57060514. [PMID: 34064050 PMCID: PMC8224075 DOI: 10.3390/medicina57060514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/13/2022]
Abstract
Syncope accounts for up to 2% of emergency department visits and results in the hospitalization of 12–86% of patients. There is often a low diagnostic yield, with up to 50% of hospitalized patients being discharged with no clear diagnosis. We will outline a structured approach to the syncope patient in the emergency department, highlighting the evidence supporting the role of clinical judgement and the initial electrocardiogram (ECG) in making the preliminary diagnosis and in safely identifying the patients at low risk of short- and long-term adverse events or admitting the patient if likely to benefit from urgent intervention. Clinical decision tools and additional testing may aid in further stratifying patients and may guide disposition. While hospital admission does not seem to offer additional mortality benefit, the efficient utilization of outpatient testing may provide similar diagnostic yield, preventing unnecessary hospitalizations.
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11
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Ostroumova TM, Ostroumova OD, Akimova ES, Kochetkov AI. [Drug-induced seizures: prevalence, risk factors, treatment and prevention]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:86-97. [PMID: 31851178 DOI: 10.17116/jnevro201911911186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a growing interest to the problem of drug-induced epileptic seizures (ES) due to their relatively high prevalence, poor prognosis, a large number of different drugs associated with the development of drug-induced ES, and low awareness among general practitioners. Drug-induced ES are most often associated with the use of antidepressants, antipsychotics, antiepileptic drugs (overdose or as a result of discontinuation), antibiotics, immunosuppressants and immunomodulators, antitumor agents, analgesics, central nervous system stimulators, anesthetics etc. The prevalence of drug-induced ES varies with different drugs. It is estimated that about 6.1% of the first occurring ES are drug-induced. Risk factors for drug-induced ES include a history of epilepsy or ES, cancer, blood-brain barrier dysfunction, several concomitant neurological diseases, mental disorders, childhood, old and very old age, fever, impaired liver metabolism in patients with liver diseases, impaired drug excretion in patients with kidney diseases, polypharmacy, pharmacokinetic properties of the drugs themselves, allowing them to penetrate the blood-brain barrier in the central nervous system (lipophilicity, transport and communication with blood plasma proteins), drug concentration in blood serum, method and frequency of drug administration, single and daily doses of drugs. No clinical guidelines for the management of patients with drug-induced ES are available. It is recommended to identify patients at risk: elderly patients, patients with impaired liver and kidney function and patients receiving drugs that can cause ES and/or lower the seizure threshold. Benzodiazepines are the first-line treatment in drug-induced status epilepticus, barbiturates and propofol are the second-line treatment. The general principles for the prevention of drug-induced ES include careful selection of the optimal dose of drugs that can cause ES, especially in patients with impaired liver and/or kidney function, monitoring of several parameters in blood serum (for example, liver enzymes, electrolytes, glucose etc.), monitoring of the blood plasma concentration of certain drugs, avoiding the simultaneous administration of several drugs that stimulate the central nervous system, and a rapid discontinuation of such drugs.
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Affiliation(s)
- T M Ostroumova
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow,Russia
| | - O D Ostroumova
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow,Russia; Pirogov Russian National Research Medical University' Russian Clinical and Research Center of Gerontology, Moscow, Russia
| | - E S Akimova
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A I Kochetkov
- Pirogov Russian National Research Medical University' Russian Clinical and Research Center of Gerontology, Moscow, Russia
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12
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Albassam OT, Redelmeier RJ, Shadowitz S, Husain AM, Simel D, Etchells EE. Did This Patient Have Cardiac Syncope?: The Rational Clinical Examination Systematic Review. JAMA 2019; 321:2448-2457. [PMID: 31237649 DOI: 10.1001/jama.2019.8001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Syncope can result from a reduction in cardiac output from serious cardiac conditions, such as arrhythmias or structural heart disease (cardiac syncope), or other causes, such as vasovagal syncope or orthostatic hypotension. OBJECTIVE To perform a systematic review of studies of the accuracy of the clinical examination for identifying patients with cardiac syncope. STUDY SELECTION Studies of adults presenting to primary care, emergency departments, or referred to specialty clinics. DATA EXTRACTION AND SYNTHESIS Relevant data were abstracted from articles in databases through April 9, 2019, and methodologic quality was assessed. Included studies had an independent comparison to a reference standard. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, and likelihood ratios (LRs). RESULTS Eleven studies of cardiac syncope (N = 4317) were included. Age at first syncope of at least 35 years was associated with greater likelihood of cardiac syncope (n = 323; sensitivity, 91% [95% CI, 85%-97%]; specificity, 72% [95% CI, 66%-78%]; LR, 3.3 [95% CI, 2.6-4.1]), while age younger than 35 years was associated with a lower likelihood (LR, 0.13 [95% CI, 0.06-0.25]). A history of atrial fibrillation or flutter (n = 323; sensitivity, 13% [95% CI, 6%-20%]; specificity, 98% [95% CI, 96%-100%]; LR, 7.3 [95% CI, 2.4-22]), or known severe structural heart disease (n = 222; range of sensitivity, 35%-51%, range of specificity, 84%-93%; range of LR, 3.3-4.8; 2 studies) were associated with greater likelihood of cardiac syncope. Symptoms prior to syncope that were associated with lower likelihood of cardiac syncope were mood change or prodromal preoccupation with details (n = 323; sensitivity, 2% [95% CI, 0%-5%]; specificity, 76% [95% CI, 71%-81%]; LR, 0.09 [95% CI, 0.02-0.38]), feeling cold (n = 412; sensitivity, 2% [95% CI, 0%-5%]; specificity, 89% [95% CI, 85%-93%]; LR, 0.16 [95% CI, 0.06-0.64]), or headache (n = 323; sensitivity, 3% [95% CI, 0%-7%]; specificity, 80% [95% CI, 75%-85%]; LR, 0.17 [95% CI, 0.06-0.55]). Cyanosis witnessed during the episode was associated with higher likelihood of cardiac syncope (n = 323; sensitivity, 8% [95% CI, 2%-14%]; specificity, 99% [95% CI, 98%-100%]; LR, 6.2 [95% CI, 1.6-24]). Mood changes after syncope (n = 323; sensitivity, 3% [95% CI, 0%-7%]; specificity, 83% [95% CI, 78%-88%]; LR, 0.21 [95% CI, 0.06-0.65]) and inability to remember behavior prior to syncope (n = 323; sensitivity, 5% [95% CI, 0%-9%]; specificity, 82% [95% CI, 77%-87%]; LR, 0.25, [95% CI, 0.09-0.69]) were associated with lower likelihood of cardiac syncope. Two studies prospectively validated the accuracy of the multivariable Evaluation of Guidelines in Syncope Study (EGSYS) score, which is based on 6 clinical variables. An EGSYS score of less than 3 was associated with lower likelihood of cardiac syncope (n = 456; range of sensitivity, 89%-91%, range of specificity, 69%-73%; range of LR, 0.12-0.17; 2 studies). Cardiac biomarkers show promising diagnostic accuracy for cardiac syncope, but diagnostic thresholds require validation. CONCLUSIONS AND RELEVANCE The clinical examination, including the electrocardiogram as part of multivariable scores, can accurately identify patients with and without cardiac syncope.
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Affiliation(s)
- Omar T Albassam
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Robert J Redelmeier
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steven Shadowitz
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aatif M Husain
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
- Neuroscience Medicine, Duke Clinical Research Institute, Durham, North Carolina
- Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, North Carolina
| | - David Simel
- Division of General Internal Medicine, Duke Veterans Affairs Medical Center, Durham, North Carolina
- Duke University, Durham, North Carolina
| | - Edward E Etchells
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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13
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Beversdorf A. Syncope in the Pediatric Patient: A Case Report. J Pediatr Health Care 2019; 33:332-335. [PMID: 30472028 DOI: 10.1016/j.pedhc.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/19/2018] [Accepted: 09/22/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Alexa Beversdorf
- Alexa Beversdorf, Doctorate of Nursing Practice Student, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI..
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Ninni S, Kouakam C, Szurhaj W, Baille G, Klug D, Lacroix D, Derambure P. Usefulness of head-up tilt test combined with video electroencephalogram to investigate recurrent unexplained atypical transient loss of consciousness. Arch Cardiovasc Dis 2019; 112:82-94. [PMID: 30600217 DOI: 10.1016/j.acvd.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Convulsive syncope and epileptic seizure share many similar clinical features. Early diagnosis is critical for choosing the appropriate management strategy. AIM Our aim was to evaluate the diagnostic yield of an innovative diagnostic strategy - combined head-up tilt test (HUT)/video electroencephalogram (EEG) monitoring - in patients with unexplained seizure-like transient loss of consciousness (T-LOC). METHODS Combined HUT/video EEG was performed in patients with unexplained atypical T-LOC with both syncope and seizure characteristics remaining undiagnosed after a first-line investigation. T-LOC diagnosis was achieved in case of reproduction of usual symptoms. Events were classified as vasovagal, psychogenic or epilepsy. The link between EEG abnormalities and T-LOC was determined by an epilepsy specialist. Clinical follow-up was performed to assess T-LOC recurrence. RESULTS Hundred and one consecutive patients were prospectively enrolled (median age 26 [19; 46] years; 72% female) and underwent combined HUT/video EEG between 2007 and 2015. Antiepileptic drugs were being prescribed in 42% of patients. Combined HUT/video EEG was diagnostic in 67% of patients, leading to diagnosis of vasovagal syncope in 59 patients and psychogenic pseudosyncope in nine cases. Antiepileptic drugs were discontinued in 18 patients without epilepsy. Independent predictors of a definitive diagnosis were the presence of prodromal symptoms (odds ratio 5.97, 95% confidence interval 1.37-26; P=0.017) and a history of myoclonic jerks during T-LOC (odds ratio 4.36, 95% confidence interval 1.71-11.15; P=0.002). CONCLUSIONS Combined HUT/video EEG is useful for investigating recurrent unexplained atypical seizure-like T-LOC, especially in patients with a history of myoclonic jerks or with documented interictal non-specific EEG abnormalities.
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Affiliation(s)
- Sandro Ninni
- Clinique cardiologique, Institut Cœur-Poumon, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59037 Lille, France.
| | - Claude Kouakam
- Clinique cardiologique, Institut Cœur-Poumon, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59037 Lille, France
| | - William Szurhaj
- Service de neurophysiologie clinique, hôpital Roger-Salengro, CHRU de Lille, avenue du Professeur-Emile-Laine, 59037 Lille, France
| | - Guillaume Baille
- Service de neurophysiologie clinique, hôpital Roger-Salengro, CHRU de Lille, avenue du Professeur-Emile-Laine, 59037 Lille, France
| | - Didier Klug
- Clinique cardiologique, Institut Cœur-Poumon, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59037 Lille, France
| | - Dominique Lacroix
- Clinique cardiologique, Institut Cœur-Poumon, CHRU de Lille, boulevard du Professeur-Jules-Leclercq, 59037 Lille, France
| | - Philippe Derambure
- Service de neurophysiologie clinique, hôpital Roger-Salengro, CHRU de Lille, avenue du Professeur-Emile-Laine, 59037 Lille, France
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Gauvin DV, Zimmermann ZJ, Yoder J, Harter M, Holdsworth D, Kilgus Q, May J, Dalton J, Baird TJ. A predictive index of biomarkers for ictogenesis from tier I safety pharmacology testing that may warrant tier II EEG studies. J Pharmacol Toxicol Methods 2018; 94:50-63. [PMID: 29751085 DOI: 10.1016/j.vascn.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 12/20/2022]
Abstract
Three significant contributions to the field of safety pharmacology were recently published detailing the use of electroencephalography (EEG) by telemetry in a critical role in the successful evaluation of a compound during drug development (1] Authier, Delatte, Kallman, Stevens & Markgraf; JPTM 2016; 81:274-285; 2] Accardi, Pugsley, Forster, Troncy, Huang & Authier; JPTM; 81: 47-59; 3] Bassett, Troncy, Pouliot, Paquette, Ascaha, & Authier; JPTM 2016; 70: 230-240). These authors present a convincing case for monitoring neocortical biopotential waveforms (EEG, ECoG, etc) during preclinical toxicology studies as an opportunity for early identification of a central nervous system (CNS) risk during Investigational New Drug (IND) Enabling Studies. This review is about "ictogenesis" not "epileptogenesis". It is intended to characterize overt behavioral and physiological changes suggestive of drug-induced neurotoxicity/ictogenesis in experimental animals during Tier 1 safety pharmacology testing, prior to first dose administration in man. It is the presence of these predictive or comorbid biomarkers expressed during the requisite conduct of daily clinical or cage side observations, and in early ICH S7A Tier I CNS, pulmonary and cardiovascular safety study designs that should initiate an early conversation regarding Tier II inclusion of EEG monitoring. We conclude that there is no single definitive clinical marker for seizure liability but plasma exposures might add to set proper safety margins when clinical convulsions are observed. Even the observation of a study-related full tonic-clonic convulsion does not establish solid ground to require the financial and temporal investment of a full EEG study under the current regulatory standards. PREFATORY NOTE For purposes of this review, we have adopted the FDA term "sponsor" as it refers to any person who takes the responsibility for and initiates a nonclinical investigations of new molecular entities; FDA uses the term "sponsor" primarily in relation to investigational new drug application submissions.
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Affiliation(s)
- David V Gauvin
- Neurobehavioral Science and MPI Research (A Charles Rivers Company), Mattawan, MI, United States.
| | - Zachary J Zimmermann
- Neurobehavioral Science and MPI Research (A Charles Rivers Company), Mattawan, MI, United States
| | - Joshua Yoder
- Neurobehavioral Science and MPI Research (A Charles Rivers Company), Mattawan, MI, United States
| | - Marci Harter
- Safety Pharmacology, MPI Research (A Charles Rivers Company), Mattawan, MI, United States
| | - David Holdsworth
- Safety Pharmacology, MPI Research (A Charles Rivers Company), Mattawan, MI, United States
| | - Quinn Kilgus
- Safety Pharmacology, MPI Research (A Charles Rivers Company), Mattawan, MI, United States
| | - Jonelle May
- Safety Pharmacology, MPI Research (A Charles Rivers Company), Mattawan, MI, United States
| | - Jill Dalton
- Safety Pharmacology, MPI Research (A Charles Rivers Company), Mattawan, MI, United States
| | - Theodore J Baird
- Drug Safety Assessment, MPI Research (A Charles Rivers Company), Mattawan, MI, United States
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Izumi M, Okabe T, Komura M, Hayashi Y. Convulsive syncope on electroencephalogram. J Gen Fam Med 2018; 19:109-110. [PMID: 29744265 PMCID: PMC5931353 DOI: 10.1002/jgf2.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/12/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Manabu Izumi
- Department of General Medicine; Saiseikai Utsunomiya Hospital; Tochigi Japan
| | - Taro Okabe
- Department of General Medicine; Saiseikai Utsunomiya Hospital; Tochigi Japan
| | - Masayoshi Komura
- Department of General Medicine; Saiseikai Utsunomiya Hospital; Tochigi Japan
| | - Yasushi Hayashi
- Department of General Medicine; Saiseikai Utsunomiya Hospital; Tochigi Japan
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17
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Pana R, Labbé A, Dubeau F, Kobayashi E. Evaluation of the "non-epileptic" patient in a tertiary center epilepsy clinic. Epilepsy Behav 2018; 79:100-105. [PMID: 29268170 DOI: 10.1016/j.yebeh.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/23/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The epilepsy clinic at the Montreal Neurological Institute receives a high volume of referrals. Despite most patients assessed in the clinic eventually being diagnosed with epilepsy, other disorders causing alteration of consciousness or paroxystic symptoms that could be misdiagnosed as seizures are seen frequently. The incidence and clinical characteristics of such patients have not yet been determined. We aimed to determine the proportion and clinical characteristics of patients referred to our epilepsy clinic who had a final diagnosis other than epilepsy. METHODS We performed a retrospective chart analysis of consecutive patient referrals to the epilepsy clinic from January 2013 to January 2015, inclusively. RESULTS Four hundred four patient referrals were evaluated, 106 (or 26%) had a final diagnosis other than epilepsy. Referrals came primarily from general practitioners and nonneurology specialists. Although most patients had a normal routine electroencephalography (EEG) prior to the clinic visit, sleep-deprived EEG and cardiac investigations were rarely performed. Patients received a final diagnosis other than epilepsy after 1 to 2 visits in 92% of cases and with minimal paraclinical investigations. Prolonged video-EEG recording was required in 27% of patients. The most common diagnoses were syncope (33%), psychiatric symptoms (20%), followed by migraine (10%), and psychogenic nonepileptic seizures (9%). CONCLUSIONS A significant proportion of patients seen in our tertiary care epilepsy clinic is in fact, not patients with epilepsy. Enhanced knowledge of these differential diagnosis and important anamnesis components to rule out seizures will help improve guidelines for referral to Epilepsy clinic and cost-effectively optimize the use of paraclinical investigations.
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Affiliation(s)
- Raluca Pana
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Aurélie Labbé
- Department of Decision Sciences, HEC Montreal, Canada
| | - François Dubeau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Eliane Kobayashi
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Canada.
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Labate A, Mumoli L, Curcio A, Tripepi G, D'Arrigo G, Ferlazzo E, Aguglia U, Indolfi C, Quattrone A, Gambardella A. Value of clinical features to differentiate refractory epilepsy from mimics: a prospective longitudinal cohort study. Eur J Neurol 2018; 25:711-717. [PMID: 29359374 DOI: 10.1111/ene.13579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/11/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Misdiagnosis of refractory epilepsy (rE) is common and such patients experience a long diagnostic delay. Our aim was to identify key clinical/laboratory factors in order to obtain an alternative diagnosis in patients referred for rE. METHODS Between January 2010 and December 2015, 125 consecutive patients with a diagnosis of rE were prospectively enrolled. All patients underwent a comprehensive neurological, neuropsychiatric and cardiological evaluation, and had an observation time of at least 1 year after the study entry. RESULTS Diagnosis of rE was confirmed in 104/125 (83.2%) patients (55 women, mean age 38.8 ± 14.3 years). Thirteen/125 patients (10.4%, seven women, mean age 50.8 ± 20.9) were diagnosed with syncope, which was cardiac/cardio inhibitory in 9/13 (69%). The remaining 8/125 patients (6.4%, six women, mean age 41.2 ± 14.6 years) were diagnosed with psychogenic non-epileptic seizures. Age at onset had a high accuracy in differentiating patients with syncope from others, with the best cut-off age at 35 years and above. Abnormal brain magnetic resonance imaging (MRI) had a significant yield of about 70% in rE. A diagnostic model including age at onset and brain MRI was highly accurate in differentiating patients with syncope from others. In patients with cardiac/cardio inhibitory syncope, the point score of historical features was ≥1 and falsely favoured the diagnosis of epileptic seizures. CONCLUSIONS This prospective cohort study identifies rE mimics who are at high risk of morbidity and mortality. rE starting in adulthood should raise a high suspicion of cardiac syncope. Brain MRI is accurate in differentiating rE from other conditions.
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Affiliation(s)
- A Labate
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - L Mumoli
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - A Curcio
- Institute of Cardiology, University Magna Graecia, Catanzaro, Italy
| | - G Tripepi
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - G D'Arrigo
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - E Ferlazzo
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - U Aguglia
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy
| | - C Indolfi
- Institute of Cardiology, University Magna Graecia, Catanzaro, Italy
| | - A Quattrone
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - A Gambardella
- Institute of Neurology, University Magna Graecia, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2017; 136:e60-e122. [DOI: 10.1161/cir.0000000000000499] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | | | - David G. Benditt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mitchell I. Cohen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Daniel E. Forman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Blair P. Grubb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mohamed H. Hamdan
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Andrew D. Krahn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Mark S. Link
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Satish R. Raj
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Roopinder Kaur Sandhu
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Dan Sorajja
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Benjamin C. Sun
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
| | - Clyde W. Yancy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. HRS Representative. ACEP and SAEM Joint Representative. ACC/AHA Task Force on Performance Measures Liaison
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21
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Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 14:e155-e217. [PMID: 28286247 DOI: 10.1016/j.hrthm.2017.03.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Indexed: 12/26/2022]
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22
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Johnson EL, Krauss GL. Evaluating and Treating Epilepsy Based on Clinical Subgroups. Neurol Clin 2016; 34:595-610. [DOI: 10.1016/j.ncl.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Raj S, Sheldon R. Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope. Arrhythm Electrophysiol Rev 2016; 5:122-9. [PMID: 27617091 PMCID: PMC5013178 DOI: 10.15420/aer.2016.7.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/26/2016] [Indexed: 01/14/2023] Open
Abstract
Postural tachycardia syndrome (POTS), inappropriate sinus tachycardia (IST) and vasovagal syncope (VVS) are relatively common clinical syndromes that are seen by physicians in several disciplines. They are often not well recognised and are poorly understood by physicians, are associated with significant morbidity and cause significant frustration for both patients and their physicians. The 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope provides physicians with an introduction to these disorders and initial recommendations on their investigation and treatment. Here we summarise the consensus statement to help physicians in the management of patients with these frequently distressing problems.
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Affiliation(s)
- Satish Raj
- Libin Cardiovascular Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Robert Sheldon
- Libin Cardiovascular Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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