Generalized tonic-clonic seizures detected by implantable loop recorder devices: diagnosing more than cardiac arrhythmias
Abstract
Background Both syncope and seizures are important causes of recurrent, unexplained episodes of loss of consciousness. Implantable loop recorders have identified serious arrhythmias in patients with repeated syncope; however, implantable loop recorder detection of seizures is less well established.Objectives The purpose of this study was to provide in-depth analysis of a characteristic myopotential pattern recorded by implantable loop recorders during generalized tonic-clonic seizures.Methods Fourteen patients with refractory, video-EEG-documented epilepsy (complex partial, atonic, tonic, or generalized tonic-clonic seizures) underwent implantable loop recorder placement as part of a study protocol evaluating cardiac rhythm abnormalities in patients at high risk for sudden unexpected death in epilepsy.Results Twelve generalized tonic-clonic seizure episodes were detected by the implantable loop recorder in six patients. Implantable loop recorder and EEG recordings of generalized tonic-clonic seizures were identical and revealed a tonic phase (sustained, rapid, high-frequency myopotentials) transitioning to a clonic phase (periodic bursts of high-frequency myopotentials with a decelerating burst frequency from 3-6 Hz to 1-2 Hz) prior to seizure termination. With the nonprogrammable bandpass filter of 0.85 to 32 Hz in the implantable loop recorder, all generalized tonic-clonic seizure episodes had escaped automatic detection and required activation by family members. None of the 76 nongeneralized tonic-clonic seizure episodes recorded on the implantable loop recorder in the 14 patients exhibited the stereotypical tonic-clonic pattern that defines generalized seizures.Conclusion Recognizing this specific myopotential pattern on an implantable loop recorder might help diagnose generalized tonic-clonic seizures as a cause of recurrent, unexplained episodes of loss of consciousness. Having a programmable bandpass filter in the implantable loop recorder might increase its diagnostic yield for such patients.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In patients in whom epilepsy was suspected but the treatment has proven ineffective, an attack could have been documented by ILR in 62% of patients, with an arrhythmic cause being responsible in 26%.
“Patients in whom epilepsy was suspected but the treatment has proven ineffective: in pooled data, an attack could have been documented by ILR in 62% of patients, with an arrhythmic cause being responsible in 26% 137,189-191”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [189]
Cites
Electroencephalography—Basic principles, clinical applications and related fields
(1982) · Journal of the Autonomic Nervous System · doi:10.1016/0165-1838(82)90067-4 · Cited by 3,449 · see citing works
Epilepsy: A Comprehensive Textbook
(2008) · JAMA · doi:10.1001/jama.300.4.443-a · Cited by 2,355 · see citing works
Adams, R. D., & Victor, M. (1977) · Medical Entomology and Zoology · Cited by 1,718 · see citing works
Electrodiagnosis in Diseases of Nerve and Muscle
Kimura, J. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199738687.001.0001 · Cited by 586 · see citing works
Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause
Zaidi, A., Clough, P., Cooper, P., Scheepers, B., & Fitzpatrick, A. P. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00700-2 · Cited by 422 · see citing works
Use of an Extended Monitoring Strategy in Patients With Problematic Syncope
Krahn, A. D., Klein, G. J., Yee, R., Takle-Newhouse, T., & Norris, C. (1999) · Circulation · doi:10.1161/01.cir.99.3.406 · Cited by 360 · see citing works
Electrodiagnosis in Diseases of Nerve and Muscle
Katirji, M. B. (1990) · Neurology · doi:10.1212/wnl.40.5.869 · Cited by 205 · see citing works
Niedermeyer, E., Froescher, W., & Fisher, R. S. (1985) · Journal of Neurology · doi:10.1007/bf00314032 · Cited by 180 · see citing works
Electrocerebral Accompaniments of Syncope Associated with Malignant Ventricular Arrhythmias
Aminoff, M. J., SCHEINMAN, M. M., Griffin, J. C., & HERRE, J. M. (1988) · Annals of Internal Medicine · doi:10.7326/0003-4819-108-6-791 · Cited by 129 · see citing works
Shaw, D. M., Kellam, A. M. P., & Mottram, R. F. (1982) · Elsevier eBooks · doi:10.1016/b978-0-407-00236-4.50014-8 · Cited by 60 · see citing works
Vinton, A., Carino, J., Vogrin, S. J., MacGregor, L., Kilpatrick, C. J., Matkovic, Z., & O'Brien, T. J. (2004) · Epilepsia · doi:10.1111/j.0013-9580.2004.04704.x · Cited by 58 · see citing works
Gimbel, J., Zarghami, J., Machado, C., et al. (2005) · Annals of Noninvasive Electrocardiology · doi:10.1111/j.1542-474x.2005.00056.x · Cited by 48 · see citing works
de Cock, C. C., Spruijt, H. J., CAMPEN, L. C. M. C. V., PLU, A. W., & Visser, C. A. (2000) · Pacing and Clinical Electrophysiology · doi:10.1046/j.1460-9592.2000.01516.x · Cited by 37 · see citing works
Recurrent Seizure Diagnosed by the Insertable Loop Recorder
Simpson, C. S., BARLOW, M. A., Krahn, A. D., Klein, G. J., Yee, R. K., & Skanes, A. C. (2000) · Journal of Interventional Cardiac Electrophysiology · doi:10.1023/a:1009804429745 · Cited by 10 · see citing works
Misdiagnosis of epilepsy. Epilepsy care is deficient for both patients and doctors.
Morton, R. (2002) · PubMed · Cited by 8 · see citing works
Interference by Cellular Telephone with an Implantable Loop Recorder
TRIGANO, A. J., Blandeau, O., & Lévy, S. (2005) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-005-0303-4 · Cited by 3 · see citing works
Osman, F., Ahmad, R., Davis, R., et al. (2005) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2005.50019.x · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951 · see citing works
Maggi, R., Rafanelli, M., Ceccofiglio, A., Solari, D., Brignole, M., & Ungar, A. (2014) · Europace · doi:10.1093/europace/euu051 · Cited by 37 · see citing works
- Authors
- Ho, R. T., Wicks, T., Wyeth, D., & Nei, M.
- Affiliations
- Thomas Jefferson University Hospital (US)
- Corresponding author
- Ho, Reginald T.
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2006-07
- Volume
- 3
- Issue
- 7
- Pages
- 857-861
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2005546577
- Cited by
- 35
- References
- 17
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2021: 1 · 2019: 4 · 2018: 3 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 3 · 2012: 3
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medtronic
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- generalized tonic-clonic seizures, implantable loop recorder, seizure detection, loss of consciousness, syncope, drug-resistant epilepsy, sudden unexpected death in epilepsy, bandpass filter
- MeSH terms
- Adult, Arrhythmias, Cardiac, Diagnosis, Differential, Electrocardiography, Equipment Design, Female, Humans, Male, Middle Aged, Seizures, Prostheses and Implants
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
