유년기 근간대성 간질 환자의혈관억제성 기립경사 검사 반응
Vasodepressive Response of Head-up Tilt-Table Testin Patients With Juvenile Myoclonic Epilepsy
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Background: Juvenile myoclonic epilepsy (JME) is characterized by myoclonic seizures on awakening and giant somatosensory evoked potentials. Those characteristics suggest that JME is related with dysfunction of the brainstem reticular formation. Cardiovascular reflex is also closely related with the brainstem reticular formation, and head-up tilt-table test (HUT) is frequently employed to evaluate the cardiovascular reflex. We performed HUT to assess the cardiovascular reflex in patients with JME and syncope/presyncope. Methods: We included 52 patients with alleged JME. HUT was performed in 20 of them with a history of presyncope or syncope. The protocol of HUT included 70 degree table tilting test and isoproterenol infusion test (1~5 μg/min). We determined the positive responses according to the change of blood pressure and heart rate. The positive responses were classified as vasodepressive, cardioinhibitory, or mixed types. We retrospectively analyzed the clinical findings and responses of HUT. Results: Syncope or presyncope occurred during the seizure-prone situation in 3 (15%), and during the syncope-prone situation in 17 (85%) patients. Fifteen (75%) patients had positive responses in HUT. The positive responses were during the baseline test in 1 (5%), during the low dose (≤ 3 μg/min) of isoproterenol infusion in 10 (50%), and during the high dose (≥ 4 μg/min) of isoproterenol infusion in the remaining 4 (20%) patients. All the positive responses were vasodepressive type. Conclusions: In patients with JME, vasomotor reflex may be impaired. Our results suggest dysfunction of the brainstem reticular formation in JME.
Abstract
Background: Juvenile myoclonic epilepsy (JME) is characterized by myoclonic seizures on awakening and giant somatosensory evoked potentials. Those characteristics suggest that JME is related with dysfunction of the brainstem reticular formation. Cardiovascular reflex is also closely related with the brainstem reticular formation, and head-up tilt-table test (HUT) is frequently employed to evaluate the cardiovascular reflex. We performed HUT to assess the cardiovascular reflex in patients with JME and syncope/presyncope. Methods: We included 52 patients with alleged JME. HUT was performed in 20 of them with a history of presyncope or syncope. The protocol of HUT included 70 degree table tilting test and isoproterenol infusion test (1~5 μg/min). We determined the positive responses according to the change of blood pressure and heart rate. The positive responses were classified as vasodepressive, cardioinhibitory, or mixed types. We retrospectively analyzed the clinical findings and responses of HUT. Results: Syncope or presyncope occurred during the seizure-prone situation in 3 (15%), and during the syncope-prone situation in 17 (85%) patients. Fifteen (75%) patients had positive responses in HUT. The positive responses were during the baseline test in 1 (5%), during the low dose (≤ 3 μg/min) of isoproterenol infusion in 10 (50%), and during the high dose (≥ 4 μg/min) of isoproterenol infusion in the remaining 4 (20%) patients. All the positive responses were vasodepressive type. Conclusions: In patients with JME, vasomotor reflex may be impaired. Our results suggest dysfunction of the brainstem reticular formation in JME.
참고문헌 (40)
- Grunewald RA, "Juvenile myoclonic epilepsy", A review, 50, pp.594~598 (1993), Arch Neurol
- Janz D, "Epilepsy with impulsive petit mal (juvenile myoclonic epilepsy)", Acta Neurol Scand, 72, pp.449~459 (1985)
- Panayiotopoulos CP, "Juvenile myoclonic epilepsy: a 5-year prospective study", Epilepsia, 35, pp.285~296 (1994)
- Lee NS, "Juvenile myoclonic epilepsy of Janz", J Korean Neurol Assoc, 8, pp.104~108 (1990)
- Tae WS, "Volume changes of frontal lobe epilepsy and hippocampus in juvenile myoclonic epilepsy", J Korean Neurol Assoc, 21, pp.54~61 (2003)
- Kim H, "Seizure type and EEG findings of juvenile onset idiopathic generalized epilepsy", J Korean Pediatr Soc, 40, pp.991~998 (1997)
- Grubb BP, "Utility of upright tilt-table testing in the evaluation and management of syncope of unknown origin", Am J Med, 90, pp.6~10 (1991)
- Benditt DG, "Tilt table testing for assessing syncope. American College of Cardiology", J Am Coll Cardiol, 28, pp.263~275 (1996)
- Lurie KG, "Syncope and the autonomic nervous system", J Cardiovasc Electrophysiol, 7, pp.760~776 (1996)
- Hilz MJ, "Decrease of sympathetic cardiovascular modulation after temporal lobe epilepsy surgery", Brain, 125, pp.985~995 (2002)
- Tinuper P, "Ictal bradycardia in partial epileptic seizures: Autonomic investigation in three cases and literature review", Brain, 124, pp.2361~2371 (2001)
- Tomson T, "Heart rate variability in patients with epilepsy", Epilepsy Res, 30, pp.77~83 (1998)
- Pedersen SB, "Juvenile myoclonic epilepsy: clinical and EEG features", Acta Neurol Scand, 97, pp.160~163 (1998)
- Brignole M, "Carotid sinus massage, eyeball compression, and head-up tilt test in patients with syncope of uncertain origin and in healthy control subjects", Am Heart J, 122, pp.1644~1651 (1991)
- Natale A, "Provocation of hypotension during head-up tilt testing in subjects with no history of syncope or presyncope", Circulation, 92, pp.54~58 (1995)
- Day SC, "Evaluation and outcome of emergency room patients with transient loss of consciousness", Am J Med, 73, pp.15~23 (1982)
- Gendelman HE, "Syncope in a general hospital patient population. Usefulness of the radionuclide brain scan, electroencephalogram, and 24-hour Holter monitor", N Y State J Med, 83, pp.1161~1165 (1983)
- Grubb BP, "Reproducibility of head upright tilt table test results in patients with syncope", Pacing Clin Electrophysiol, 15, pp.1477~1481 (1992)
- Brooks R, "Prospective evaluation of day-to-day reproducibility of upright tilt-table testing in unexplained syncope", Am J Cardiol, 71, pp.1289~1292 (1993)
- Sheldon R, "Reproducibility of isoproterenol tilt-table tests in patients with syncope", Am J Cardiol, 69, pp.1300~1305 (1992)
- Fitzpatrick AP, "Methodology of head-up tilt testing in patients with unexplained syncope", J Am Coll Cardiol, 17, pp.125~130 (1991)
- Fish FA, "Reproducibility of a symptomatic response to upright tilt in young patients with unexplained syncope", Am J Cardiol, 70, pp.605~609 (1992)
- Kochiadakis GE, "Reproducibility of tilt table testing in patients with vasovagal syncope and its relation to variations in autonomic nervous system activity", Pacing Clin Electrophysiol, 21, pp.1069~1076 (1998)
- Grubb BP, "Tilt table testing: concepts and limitations", Pacing Clin Electrophysiol, 20, pp.781~787 (1997)
- Almquist A, "Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope", N Engl J Med, 320, pp.346~351 (1989)
- Fitzpatrick A, "Tilting towards a diagnosis in recurrent unexplained syncope", Lancet, 1, pp.658~660 (1989)
- Fitzpatrick A, "The incidence of malignant vasovagal syndrome in patients with recurrent syncope", Eur Heart J, 12, pp.389~394 (1991)
- Raviele A, "Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study", Am J Cardiol, 65, pp.1322~1327 (1990)
- Kim PH, "Frequency of arrhythmic events during head-up tilt testing in patients with suspected neurocardiogenic syncope or presyncope", Am J Cardiol, 94, pp.1491~1495 (2004)
- Razvi SS, "Tilt table testing in patients referred from an epilepsy clinic", Seizure, 12, pp.295~299 (2003)
- Janz D CW, "Impulsive petit mal", John Libbey, pp.229~251 (1994)
- Janz D, "Epilepsy with grand mal on awakening and sleep-waking cycle", Clin Neurophysiol, 111(2), pp.103~110 (2000)
- Shouse MN, "Chronobiology In Epilepsy.A comprehensive textbook", pp.1917~1928 (1997), Lippincott-Raven
- Obeso JA, "Somatosensory evoked potentials in myoclonus", Adv Neurol, 43, pp.373~384 (1986)
- Salas-Puig J, "Somatosensory evoked potentials in juvenile myoclonic epilepsy", Epilepsia, 33, pp.527~530 (1992)
- Rothwell JC, "On the significance of giant somatosensory evoked potentials in cortical myoclonus", J Neurol Neurosurg Psychiatry, 47, pp.33~42 (1984)
- Panayiotopoulos CP, "Juvenile myoclonic epilepsy: factors of error involved in the diagnosis and treatment", Epilepsia, 32, pp.672~676 (1991)
- Montalenti E, "Clinical features, EEG findings and diagnostic pitfalls in juvenile myoclonic epilepsy: a series of 63 patients", J Neurol Sci, 184, pp.65~70 (2001)
- Lancman ME, "Clinical and EEG asymmetries in juvenile myoclonic epilepsy", Epilepsia, 35, pp.302~306 (1994)
- Murthy JM, "Factors of error involved in the diagnosis of juvenile myoclonic epilepsy: A study from South India", Neurol India, 47, pp.210~213 (1999)