Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Glasgow, UK. Noran Neurological Clinic and Department of Neurology, University of Minnesota Hospitals, Minneapolis, USA. Paediatric Department, Victoria Hospital, Kirkcaldy, UK. Paediatric Neurology Department, Ninewells Hospital, Dundee, UK. Neurology Department, Paediatric Hospital no. 1, Kyiv, Ukraine
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)Presented in part by Dr Alla Nechay to the European Paediatric Neurology Society, Taormina, Italy, October 25, 2003 and by Dr Iain Horrocks to the American Epilepsy Society, Boston USA, December 9, 2003.