The DOI matches its Crossref record; 32 of the 33 references it cites were found in a registry or an index.
Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause
Open accessAbstract
Objectives We sought to investigate the value of cardiovascular tests to diagnose convulsive syncope in patients with apparent treatment-resistant epilepsy.Background As many as 20% to 30% of epileptics may have been misdiagnosed. Many of these patients may have cardiovascular syncope, with abnormal movements due to cerebral hypoxia, which may be difficult to differentiate from epilepsy on clinical grounds.Methods Seventy-four patients (33 men, mean age 38.9 +/- 18 years [range 16 to 77]) who were previously diagnosed with epilepsy were studied. Inclusion criteria included continued attacks despite adequate anticonvulsant drug treatment (n = 36) or uncertainty about the diagnosis of epilepsy, on the basis of the clinical description of the seizures (n = 38). Each patient underwent a head-up tilt test and carotid sinus massage during continuous electrocardiography, electroencephalography and blood pressure monitoring. Ten patients subsequently underwent long-term electrocardiographic (ECG) monitoring with an implantable loop recorder.Results In total, an alternative diagnosis was found in 31 patients (41.9%), including 13 (36.1%) of 36 patients taking an anticonvulsant medication. Nineteen patients (25.7%) developed profound hypotension or bradycardia during the head-up tilt test, confirming the diagnosis of vasovagal syncope. One other patient had a typical vasovagal reaction during intravenous cannulation. Two patients developed psychogenic symptoms during the head-up tilt test. Seven patients (9.5%) had significant ECG pauses during carotid sinus massage. In two patients, episodes of prolonged bradycardia correlated precisely with seizures according to the insertable ECG recorder.Conclusions A simple, noninvasive cardiovascular evaluation may identify an alternative diagnosis in many patients with apparent epilepsy and should be considered early in the management of patients with convulsive blackouts.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The frequent use of EEG has been observed in other evaluations of diagnostic pathways for patients with syncope.16,17”
From Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry (2011) · cites this paper as [17]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 [137]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Tilt testing may be helpful in separating syncope with abnormal movements from epilepsy. 137”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [137]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In the EGSYS 1 population, reflecting the clinical context in 2001, the rates of MRI and/or CT scan were 20%.17”
From Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry (2011) · cites this paper as [17]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Quality of life of people with epilepsy: a European study
Baker, G. A., Jacoby, A., Buck, D., Stalgis, C., & Monnet, D. (1997) · Epilepsia · doi:10.1111/j.1528-1157.1997.tb01128.x · Cited by 847
Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia.
Lempert, T., Bauer, M., & Schmidt, D. (1994) · Annals of Neurology · doi:10.1002/ana.410360217 · Cited by 452
The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic
Smith, D. F. (1999) · QJM · doi:10.1093/qjmed/92.1.15 · Cited by 448
ACUTE ARREST OF CEREBRAL CIRCULATION IN MAN
Kabat, H. (1943) · Archives of Neurology And Psychiatry · doi:10.1001/archneurpsyc.1943.02290230022002 · Cited by 371
Raviele, A., GASPARINI, G., Pede, F. D., Delise, P., Bonso, A., & Piccolo, E. (1990) · The American Journal of Cardiology · doi:10.1016/0002-9149(90)91321-v · Cited by 266
Diagnostic efficacy of 24-hour electrocardiographic monitoring for syncope
Gibson, T. C., & Heitzman, M. (1984) · The American Journal of Cardiology · doi:10.1016/0002-9149(84)90628-3 · Cited by 224
The misdiagnosis of epilepsy: findings of a population study
Scheepers, B. D. M., Clough, P. W. L., & Pickles, C. (1998) · Seizure · doi:10.1016/s1059-1311(05)80010-x · Cited by 220
The etiology of syncope in patients with negative tilt table and electrophysiological testing
Krahn, A. D., Klein, G. J., Norris, C., & Yee, R. (1995) · Circulation · doi:10.1161/01.cir.92.7.1819 · Cited by 215
King, D. W., Gallagher, B. B., Murvin, A. J., Smith, D. B., Marcus, D. J., Hartlage, L. C., & Ward, L. C. (1982) · Neurology · doi:10.1212/wnl.32.1.18 · Cited by 205
Use of ambulatory electrocardiographic (Holter) monitoring
DiMarco, J. P., & Philbrick, J. T. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-113-1-53 · Cited by 177
Research works printed but not linked: 3
- Gastaut H. Syncopes: generalized anoxic cerebral seizures. In: Magnus O, Lorentz de Haas AM, editors. The Epilepsies. New York: Elsevier, 1974:815–35.
- Fitzpatrick, 1991, Blood pressure and heart rate during positive and negative 60° head-up tilt testing, Eur J Card Pac Electrophysiol, 1, 25
- Silvani S, Ciucci G, Verita E, et al. Correlation between positivity type of tilt test and simultaneous EEG: preliminary results (abstr). Proceedings of the VII International Symposium on Progress in Clinical Pacing 1998;48.
Cited by
Sorted by citations
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040
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
Duncan, J. S., Sander, J. W. A. S., Sisodiya, S. M., & Walker, M. C. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68477-8 · Cited by 726
Guidelines on Management (diagnosis and treatment) of syncope ? update 2004
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janousek, J., et al. (2004) · EP Europace · doi:10.1016/j.eupc.2004.08.008 · Cited by 650
Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive Summary.
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janoušek, J., et al. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.09.004 · Cited by 566
Metadata
- Authors
- Zaidi, A., Clough, P., Cooper, P., Scheepers, B., & Fitzpatrick, A. P.
- Affiliations
- Manchester Royal Infirmary (GB)
- Salford Royal Hospital (GB)
- Corresponding author
- Zaidi, Amir
- ORCID
- Cooper, Paul
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2000-07
- Volume
- 36
- Issue
- 1
- Pages
- 181-184
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2045800993
- Cited by
- 422
- References
- 33
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 14 · 2023: 12 · 2022: 12 · 2021: 12 · 2020: 14 · 2019: 23 · 2018: 19 · 2017: 18 · 2016: 24 · 2015: 22 · 2014: 22 · 2013: 20 · 2012: 13
- FWCI
- 9.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Clinical Neurology › Epilepsy research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- epilepsy misdiagnosis, convulsive syncope, cardiovascular syncope, vasovagal syncope, drug-resistant epilepsy, head-up tilt, carotid sinus massage, implantable loop recorder, bradycardia, hypotension, psychogenic non-epileptic seizures, seizure-like events
- MeSH terms
- Adolescent, Adult, Aged, Blood Pressure, Diagnosis, Differential, Diagnostic Errors, Electroencephalography, Epilepsy, Female, Heart Rate, Humans, Male, Middle Aged, Seizures, Electrocardiography, Ambulatory, Blood Pressure Monitoring, Ambulatory, Tilt-Table Test, Syncope, Vasovagal
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
