Syncopal attacks in children: Is it cardiac or epilepsy related?

Area of Science:

• Pediatric Neurology
• Epilepsy and Seizure Disorders
• Neuroscience

Background:

• Transient loss of consciousness (TLOC) in children can be misdiagnosed as epilepsy or syncope.
• Accurate differentiation between epilepsy and syncope is essential for appropriate patient management.
• Previous criteria for distinguishing these conditions have shown variable effectiveness.

Purpose of the Study:

• To identify key symptoms differentiating epilepsy from syncope in pediatric patients with TLOC.
• To validate and compare the diagnostic accuracy of newly proposed criteria against existing ones.

Main Methods:

• Retrospective chart review of pediatric patients (≤18 years) presenting with TLOC.
• Inclusion of symptoms with high predictive accuracy for epilepsy or syncope.
• Application of receiver-operating characteristic (ROC) analyses to evaluate diagnostic performance.

Main Results:

• Analysis included 46 patients: 32 with epilepsy and 14 with syncope.
• Proposed criteria achieved 68.8% sensitivity, 85.7% specificity, and 73.9% accuracy for epilepsy prediction (AUC=0.814).
• Previously suggested criteria showed lower performance: 63.2% sensitivity, 62.5% specificity, and 63.0% accuracy (AUC=0.730).

Conclusions:

• Specific self-reported or observed symptoms can effectively distinguish epilepsy from syncope in children.
• The developed criteria demonstrate improved discriminative ability compared to existing methods.
• Further validation in larger, diverse populations is recommended before widespread clinical reliance.