Clinical Categorization of Childhood Syncope

Abstract

Syncope is a self-limited loss of consciousness produced by cerebral hypoperfusion/hypoxia. The objective of this study was to categorize the etiology and determine the frequency of concurrent epilepsy and whether laboratory testing is diagnostically useful. This was an institutional review board—approved retrospective chart review. Data were analyzed using descriptive statistics. There were 141 subjects (90 girls [63.8%]; mean age, 12.01 years). Of the syncope referrals, 86 of 123 (69.9%) had simple syncope, 35 of 123 (28.4%) had syncopal convulsions, and 2 of 123 (1.6%) had epilepsy alone. An electroencephalogram was performed in 64.7% (91/141) of the subjects but was diagnostic in 1 of 91 (1.4%) for epilepsy. Magnetic resonance imaging and/or computed tomography scans, electrocardiograms/Holter monitoring/stress testing, and blood tests were primarily normal or nondiagnostic, with 6 of 238 (2.5%) total tests contributing to the diagnosis. Primary neurocardiogenic syncope was identified in 78% (111/141) of all subjects (82% boys, 75% girls). Thirty-eight percent had syncopal convulsions, and 2.8% (4/141) had concurrent epilepsy. A detailed medical history was the most useful diagnostic tool.