Signs of autonomic arousal precede tilt-induced psychogenic nonsyncopal collapse among youth
Characterizing the physiologic changes leading up to psychogenic nonsyncopal collapse (PNSC) may help to elucidate the processes that cause paroxysmal functional neurological symptom disorders and to clinically distinguish PNSC from syncope. Thus, we aimed to characterize preictal sweat rate, heart...
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| Veröffentlicht in: | Epilepsy & behavior 2018-09, Vol.86, p.166-172 |
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| description | Characterizing the physiologic changes leading up to psychogenic nonsyncopal collapse (PNSC) may help to elucidate the processes that cause paroxysmal functional neurological symptom disorders and to clinically distinguish PNSC from syncope. Thus, we aimed to characterize preictal sweat rate, heart rate, and systolic blood pressure changes among patients with tilt-induced PNSC compared to patients with tilt-induced neurally mediated syncope. The presence of increased preictal sweating was compared between groups. Heart rates and systolic blood pressures were compared from the recumbent and tilted baselines to the periods 120 s and 30 s prior to PNSC and syncope. Patients with PNSC (n = 44) were more likely than patients with syncope (n = 44) to have preictal increases in sweating, n = 31 (70.5%) versus n = 21 (47.7%), p = 0.03, although all patients with syncope eventually developed a sweat response. Comparing the recumbent baseline to the period 30 s prior to PNSC, blood pressure (112 ± 9 versus 129 ± 13 mmHg, p |
| doi_str_mv | 10.1016/j.yebeh.2018.03.009 |
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•Psychogenic nonsyncopal collapse (PNSC) is similar to psychogenic nonepileptic seizures (PNES), but the appearance of fainting leads to different referral patterns.•Most patients with PNSC have preictal increases in sweating, heart rate, and/or blood pressure.•The increase in these signs matches the premonitory symptoms often described by patients with PNES.•A history of prodromal sweating does not distinguish PNSC from neurally-mediated syncope.</description><identifier>ISSN: 1525-5050</identifier><identifier>EISSN: 1525-5069</identifier><identifier>DOI: 10.1016/j.yebeh.2018.03.009</identifier><identifier>PMID: 30055943</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Pediatric ; PNES ; Pseudoseizure ; Pseudosyncope ; Syncope</subject><ispartof>Epilepsy & behavior, 2018-09, Vol.86, p.166-172</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-fd73407a88eeed980c480d5c58878d35fe3ad1fd30218ee816f229e1c2d012953</citedby><cites>FETCH-LOGICAL-c359t-fd73407a88eeed980c480d5c58878d35fe3ad1fd30218ee816f229e1c2d012953</cites><orcidid>0000-0001-9334-3739</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.yebeh.2018.03.009$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30055943$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heyer, Geoffrey L.</creatorcontrib><creatorcontrib>Harvey, Rebecca A.</creatorcontrib><creatorcontrib>Islam, Monica P.</creatorcontrib><title>Signs of autonomic arousal precede tilt-induced psychogenic nonsyncopal collapse among youth</title><title>Epilepsy & behavior</title><addtitle>Epilepsy Behav</addtitle><description>Characterizing the physiologic changes leading up to psychogenic nonsyncopal collapse (PNSC) may help to elucidate the processes that cause paroxysmal functional neurological symptom disorders and to clinically distinguish PNSC from syncope. Thus, we aimed to characterize preictal sweat rate, heart rate, and systolic blood pressure changes among patients with tilt-induced PNSC compared to patients with tilt-induced neurally mediated syncope. The presence of increased preictal sweating was compared between groups. Heart rates and systolic blood pressures were compared from the recumbent and tilted baselines to the periods 120 s and 30 s prior to PNSC and syncope. Patients with PNSC (n = 44) were more likely than patients with syncope (n = 44) to have preictal increases in sweating, n = 31 (70.5%) versus n = 21 (47.7%), p = 0.03, although all patients with syncope eventually developed a sweat response. Comparing the recumbent baseline to the period 30 s prior to PNSC, blood pressure (112 ± 9 versus 129 ± 13 mmHg, p < 0.001) and heart rate (76 ± 12 versus 119 ± 22 bpm, p < 0.001) increased. Similarly, comparing the tilted baseline to the period 30 s prior to PNSC, blood pressure (118 ± 12 versus 129 ± 13 mmHg, p < 0.001) and heart rate (95 ± 15 versus 119 ± 22 bpm, p < 0.001) increased. Preictal blood pressure and heart rate differed significantly between patients with PNSC and patients with syncope. In conclusion, signs of autonomic arousal (increased sweating, heart rate, and blood pressure) often precede tilt-induced PNSC. Sweating prior to fainting may not be useful in distinguishing PNSC from neurally mediated syncope.
•Psychogenic nonsyncopal collapse (PNSC) is similar to psychogenic nonepileptic seizures (PNES), but the appearance of fainting leads to different referral patterns.•Most patients with PNSC have preictal increases in sweating, heart rate, and/or blood pressure.•The increase in these signs matches the premonitory symptoms often described by patients with PNES.•A history of prodromal sweating does not distinguish PNSC from neurally-mediated syncope.</description><subject>Pediatric</subject><subject>PNES</subject><subject>Pseudoseizure</subject><subject>Pseudosyncope</subject><subject>Syncope</subject><issn>1525-5050</issn><issn>1525-5069</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kEtLxDAQgIMoPlZ_gSA9emmdNJttcvAg4gsED-pNCDGZ7mZpk9q0Qv-90V09epoZ-Ob1EXJKoaBAFxfrYsJ3XBUlUFEAKwDkDjmkvOQ5h4Xc_cs5HJCjGNcAlHJG98kBA-BcztkheXt2Sx-zUGd6HIIPrTOZ7sMYdZN1PRq0mA2uGXLn7ZiqrIuTWYUl-gT64OPkTegSbELT6C5iptvgl9kUxmF1TPZq3UQ82cYZeb29ebm-zx-f7h6urx5zw7gc8tpWbA6VFgIRrRRg5gIsN1yISljGa2Ta0toyKGlCBF3UZSmRmtICLSVnM3K-mdv14WPEOKjWRYPpII_pFVVCJSVfyGqeULZBTR9i7LFWXe9a3U-KgvrWqtbqR6v61qqAqaQ1dZ1tF4zvLdq_nl-PCbjcAJje_HTYq2gc-iTMJYmDssH9u-AL9hqLPw</recordid><startdate>201809</startdate><enddate>201809</enddate><creator>Heyer, Geoffrey L.</creator><creator>Harvey, Rebecca A.</creator><creator>Islam, Monica P.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9334-3739</orcidid></search><sort><creationdate>201809</creationdate><title>Signs of autonomic arousal precede tilt-induced psychogenic nonsyncopal collapse among youth</title><author>Heyer, Geoffrey L. ; Harvey, Rebecca A. ; Islam, Monica P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-fd73407a88eeed980c480d5c58878d35fe3ad1fd30218ee816f229e1c2d012953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Pediatric</topic><topic>PNES</topic><topic>Pseudoseizure</topic><topic>Pseudosyncope</topic><topic>Syncope</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heyer, Geoffrey L.</creatorcontrib><creatorcontrib>Harvey, Rebecca A.</creatorcontrib><creatorcontrib>Islam, Monica P.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Epilepsy & behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heyer, Geoffrey L.</au><au>Harvey, Rebecca A.</au><au>Islam, Monica P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Signs of autonomic arousal precede tilt-induced psychogenic nonsyncopal collapse among youth</atitle><jtitle>Epilepsy & behavior</jtitle><addtitle>Epilepsy Behav</addtitle><date>2018-09</date><risdate>2018</risdate><volume>86</volume><spage>166</spage><epage>172</epage><pages>166-172</pages><issn>1525-5050</issn><eissn>1525-5069</eissn><abstract>Characterizing the physiologic changes leading up to psychogenic nonsyncopal collapse (PNSC) may help to elucidate the processes that cause paroxysmal functional neurological symptom disorders and to clinically distinguish PNSC from syncope. Thus, we aimed to characterize preictal sweat rate, heart rate, and systolic blood pressure changes among patients with tilt-induced PNSC compared to patients with tilt-induced neurally mediated syncope. The presence of increased preictal sweating was compared between groups. Heart rates and systolic blood pressures were compared from the recumbent and tilted baselines to the periods 120 s and 30 s prior to PNSC and syncope. Patients with PNSC (n = 44) were more likely than patients with syncope (n = 44) to have preictal increases in sweating, n = 31 (70.5%) versus n = 21 (47.7%), p = 0.03, although all patients with syncope eventually developed a sweat response. Comparing the recumbent baseline to the period 30 s prior to PNSC, blood pressure (112 ± 9 versus 129 ± 13 mmHg, p < 0.001) and heart rate (76 ± 12 versus 119 ± 22 bpm, p < 0.001) increased. Similarly, comparing the tilted baseline to the period 30 s prior to PNSC, blood pressure (118 ± 12 versus 129 ± 13 mmHg, p < 0.001) and heart rate (95 ± 15 versus 119 ± 22 bpm, p < 0.001) increased. Preictal blood pressure and heart rate differed significantly between patients with PNSC and patients with syncope. In conclusion, signs of autonomic arousal (increased sweating, heart rate, and blood pressure) often precede tilt-induced PNSC. Sweating prior to fainting may not be useful in distinguishing PNSC from neurally mediated syncope.
•Psychogenic nonsyncopal collapse (PNSC) is similar to psychogenic nonepileptic seizures (PNES), but the appearance of fainting leads to different referral patterns.•Most patients with PNSC have preictal increases in sweating, heart rate, and/or blood pressure.•The increase in these signs matches the premonitory symptoms often described by patients with PNES.•A history of prodromal sweating does not distinguish PNSC from neurally-mediated syncope.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30055943</pmid><doi>10.1016/j.yebeh.2018.03.009</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-9334-3739</orcidid></addata></record> |
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| subjects | Pediatric PNES Pseudoseizure Pseudosyncope Syncope |
| title | Signs of autonomic arousal precede tilt-induced psychogenic nonsyncopal collapse among youth |
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