Tilt table testing in patients referred from an epilepsy clinic

Area of Science:

• Neurology
• Cardiology
• Diagnostic Medicine

Background:

• Patients referred to epilepsy clinics often present with undiagnosed blackouts.
• Distinguishing vasovagal syncope (VVS) from epilepsy is crucial for accurate diagnosis and treatment.
• Head up tilt testing (HUT) is a diagnostic tool used to evaluate autonomic function.

Purpose of the Study:

• To evaluate the diagnostic utility of head up tilt testing (HUT) in patients with suspected vasovagal syncope (VVS) referred from an epilepsy clinic.
• To determine the effectiveness of HUT in differentiating VVS from epilepsy in this patient population.

Main Methods:

• 128 patients with recurrent undiagnosed blackouts underwent HUT (70-degree tilt for 45 minutes).
• Patients were categorized pre-test as probable VVS, possible VVS, or VVS with epilepsy.
• Data analysis focused on HUT positivity and diagnostic changes.

Main Results:

• HUT was positive in 56% of patients, leading to an alternative diagnosis in 24%.
• Diagnostic changes were significantly higher in patients with possible VVS (44%) or combined VVS/epilepsy (63%) compared to probable VVS (5%).
• 27 of 45 patients on antiepileptic medication did not have epilepsy.

Conclusions:

• HUT plays a key role in confirming or excluding VVS in patients with undiagnosed blackouts presenting to epilepsy clinics.
• HUT is especially beneficial for patients with possible VVS or suspected co-existing epilepsy and VVS.
• The test aids in refining diagnoses and potentially reducing unnecessary antiepileptic drug use.