Psychogenic pseudosyncope: an underestimated and provable diagnosis

Area of Science:

• Neurology
• Psychiatry
• Cardiology

Background:

• Syncope of unknown origin is a diagnostic challenge, with 20-30% of cases remaining unexplained after initial evaluation.
• Unlike psychogenic seizures, psychogenic pseudosyncope is rarely investigated in patients with recurrent syncopal events.
• Epilepsy centers frequently encounter patients with unexplained syncope-like episodes.

Purpose of the Study:

• To estimate the frequency of psychogenic pseudosyncope in patients diagnosed with syncope of unknown origin.
• To investigate the utility of EEG-video monitoring with activation for diagnosing psychogenic pseudosyncope.
• To highlight the importance of considering psychogenic etiology in unexplained syncopal events.

Main Methods:

• Prospective evaluation of patients referred to an epilepsy center for recurrent syncope-like episodes with negative syncope workups.
• Utilized EEG-video monitoring with suggestion-based activation (induction) to provoke habitual events.
• Diagnosis required triggered events, loss of postural tone with unresponsiveness and closed eyes, and normal EEG findings (including alpha rhythm) during the event.

Main Results:

• 90% (9 of 10) of recruited patients had their habitual syncope-like episodes triggered during monitoring.
• All 9 triggered events were diagnosed as psychogenic pseudosyncope, characterized by eyes closed, unresponsiveness, and normal EEG.
• Patients diagnosed with psychogenic pseudosyncope had a mean age of 36, with symptom duration averaging 4.2 years.

Conclusions:

• Psychogenic pseudosyncope is a significant, often undiagnosed, cause of syncope of unknown origin.
• EEG-video monitoring with induction is the definitive method for diagnosing psychogenic pseudosyncope.
• Patients with unexplained syncope-like episodes should undergo this specialized monitoring to identify psychogenic etiology.