Usefulness of the Head- Up Tilt Test in Distinguishing Neural Mediated Syncope and Epilepsy in Children Aged 5-20 Years Old

M.R. Sabri, T. Mahmodiian, H.Sadri

Pediatric Department, Alzahra Hospital, Isfahan University of Medical Sciences

Abstract:

Objective: Many nonepileptic disorders may mimic epilepsy by history or clinical presentation, Neurally mediated syncope is one of the most of the important conditions that might be difficult to differentiate from epilepsy on olinical grounds. We nvestigated.

The value of the head-up tilt test (HUT) to diagnose syncope in epileptic children.

Methods: We studied 40 patients (18 girls and 22 boys) between 5 and 20 years old (mean, 11.5±3.5) who had a previous diagnosis of epilepsy . All patients underwent a HUT test.

Results: The HUT test was positive in 26patients (65%). No statistical difference was observed between the tilt positive and negative in sex, age, provocating factors, associated symptoms, family history of syncope and heart disease, findings in physical examination, and electroencephalogram result to 14% of tilt negative patients (p<0.05). Also, family history of seizure was more frequent with a positive patients (p<0.05) After 18±6 months of follow-up, 18 of 26 patients with a positive tilt test were completely asymptomatic.

Conclusion: Inadequate history taking and overemphasis on positive, family history for seizures were important causes of misdiagnosis of epilepsy in our study of the HUT test is a simple, noninvasive diagnostic tool for distinguishing syncope and epilepsy in children and should be considered early in the diagnostic plan and for determining nanagement of selected patients with a history of drop attack and loss of consciousness.

Key words: Head-up tilt test, Syncope, Epilepsy