title: Anoxic-epileptic seizures: home video recordings of epileptic seizures induced by syncopes.
abstract: Occasionally, but more often than has been reported, true epileptic seizures are triggered by non-epileptic syncopes. This combination of syncope and epileptic seizure has been called an anoxic-epileptic seizure. A few examples of such anoxic-epileptic seizures, including the induction of status epilepticus, have been reported in books and medical journals, but no video-recordings have been published. We show here home video recordings of the first three known examples of the transition from the triggering syncope and anoxic seizure, to the subsequent epileptic seizure. In the first two children, a neurally-mediated syncope, probably mediated by prolonged expiratory apnoea (so-called breath-holding spells), induces a long, clonic epileptic seizure with some features of myoclonic absence. In the third example, a compulsive Valsalva in an older autistic child provokes a vibratory tonic epileptic seizure. In addition, we show two further video clips of the most usual type of epileptic seizure induced by syncopes in very young children. In one, the video recording begins after the end of the triggering syncope and shows a rhythmic clonic seizure that includes repetitive vocalizations. The final recoding is of a spontaneous epileptic seizure with features of myoclonic absence: this child had both epilepsy and identical episodes induced by syncopes, that is, anoxic- epileptic seizures. Not only paediatricians and paediatric neurologists, but also adult neurologists and epileptologists in general, should be aware of the important clinical scenario of true epileptic seizures induced by syncopes. This phenomenon is not considered in any international classification. (Published with videosequences)
authors.affiliation: Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Glasgow, United Kingdom. john@jbpstephenson.com
authors.forename: John
authors.initials: J
authors.lastname: Stephenson
authors.forename: Galen
authors.initials: G
authors.lastname: Breningstall
authors.forename: Chris
authors.initials: C
authors.lastname: Steer
authors.forename: Martin
authors.initials: M
authors.lastname: Kirkpatrick
authors.forename: Iain
authors.initials: I
authors.lastname: Horrocks
authors.forename: Alla
authors.initials: A
authors.lastname: Nechay
authors.forename: Sameer
authors.initials: S
authors.lastname: Zuberi
mesh_terms: D000293:Adolescent; D000328:Adult; D001049:Apnea / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D001321:Autistic Disorder / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004831:Epilepsies, Myoclonic / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004832:Epilepsy, Absence / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D008297:Male; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D013575:Syncope / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014636:Valsalva Maneuver / Q000502:physiology; D014741:Video Recording