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Updated: Jun 17, 2026

Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Seizure-like activities during head-up tilt test-induced syncope
Pil Sang Song1, June Soo Kim, Jungwae Park
1Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Seizure-like activities can occur during neurally mediated reflex syncope (NMRS) episodes, sometimes leading to misdiagnosis as epilepsy. These activities during head-up tilt testing (HUT) do not appear linked to syncope severity or hemodynamic changes.
Area of Science:
- Neurology
- Cardiology
- Neurally Mediated Reflex Syncope (NMRS)
- Epilepsy Mimicry
Background:
- Neurally mediated reflex syncope (NMRS) can present with seizure-like myoclonic jerky movements, potentially leading to misdiagnosis as epilepsy.
- Seizure-like activities during head-up tilt testing (HUT) are infrequently reported in patients with NMRS.
- Understanding these seizure-like events is crucial for accurate diagnosis and management of syncope.
Purpose of the Study:
- To characterize seizure-like activities observed during HUT-induced syncope in patients with NMRS.
- To compare clinical characteristics and hemodynamic parameters between NMRS patients with and without seizure-like activities during HUT.
- To determine if seizure-like activities correlate with syncope severity or hemodynamic changes.
Main Methods:
- Retrospective review of medical records from 1,383 patients with a positive HUT.
- Inclusion of 226 patients diagnosed with NMRS for detailed analysis.
- Categorization of seizure-like activities: multifocal myoclonic, focal extremity, and upward eye deviation.
Main Results:
- Seizure-like activities were observed in 5.75% (13/226) of patients during HUT-induced syncope.
- Specific types included multifocal myoclonic (2.21%), focal (2.21%), and upward eye deviation (1.33%).
- No significant differences in clinical variables or hemodynamic parameters were found between patients with and without seizure-like activities.
Conclusions:
- Seizure-like activities are an occasional finding during HUT-induced syncope in NMRS patients.
- These activities do not appear to be associated with the severity of syncopal episodes.
- Hemodynamic changes during HUT do not seem to correlate with the presence of seizure-like activities.
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