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Calgary score and modified calgary score in the differential diagnosis between syncope and genetic generalized
Mehmet Tolga Köle1, Safiye Günes Sağer2, Utku Batu3
1Department of Pediatrics, University of Health Science, Kartal Dr. Lutfi Kirdar City Hospital, Şemsi Denizer Cad. E-5 Karayolu Cevizli Mevkii, Kartal, 34890, Istanbul, Turkey. mehmet_tolga@hotmail.com.
Insights
Calgary scoring (CS) and Modified Calgary scoring (MCS) help differentiate childhood epilepsy from syncope. Specific questions about abnormal behavior and prolonged sitting are key indicators for epilepsy and syncope, respectively.
Area of Science:
- Pediatric Neurology
- Clinical Diagnostics
- Epilepsy and Syncope Research
Background:
- Transient Loss of Consciousness (TLOC) in children presents a diagnostic challenge.
- Differentiating between genetic generalized epilepsy and syncope is crucial for appropriate management.
- Current diagnostic tools may require refinement for improved accuracy in pediatric TLOC.
Purpose of the Study:
- To evaluate the efficacy of Calgary scoring (CS) and Modified Calgary scoring (MCS) in distinguishing genetic generalized epilepsy from syncope in pediatric patients.
- To identify key clinical features that aid in the differentiation of these two conditions.
Main Methods:
- A cohort of 117 pediatric patients (<18 years) with TLOC were analyzed.
- Calgary scoring (CS) and Modified Calgary scoring (MCS) were applied.
- Statistical analysis included age, sex, episode characteristics, and family history. Specific questions regarding observed behaviors and circumstances of TLOC were assessed.
Main Results:
- Calgary scoring (CS) showed 86.9% sensitivity and 63.4% specificity (at >-1). Modified Calgary scoring (MCS) demonstrated 76.1% sensitivity and 71.8% specificity (at >-1).
- CS exhibited lower specificity and sensitivity for epilepsy when focal epilepsies were excluded.
- Witnessed abnormal behavior (e.g., posturing, limb jerking) was the strongest indicator for epilepsy (Q5). Loss of consciousness during prolonged sitting/standing was the most significant finding for syncope (Q9).
Conclusions:
- CS and MCS can aid in differentiating pediatric epilepsy from syncope, with MCS offering better specificity.
- Specific clinical questions focusing on witnessed abnormal behavior and situational triggers are highly valuable diagnostic aids.
- Further refinement of scoring systems and targeted questioning can improve diagnostic accuracy for TLOC in children.
Abstract:
The purpose of the study is to explore the use of Calgary scoring (CS) and Modified Calgary scoring (MCS) in the differentiation of genetic generalized epilepsy and syncope in children. The study involved 117 patients aged < 18 years who presented to our hospital's pediatric neurology outpatient clinic with TLOC between June 2020 and June 2022. In addition to CS and MCS scoring, all patients were subjected to statistical analysis based on their age, sex, number of episodes and distribution during the day, duration of syncope, and family history. Seventy-one patients with syncope and 46 with epilepsy were included in the study. At a CS value > - 1, sensitivity was 86.9% and specificity 63.4%, while at an MCS value > - 1, sensitivity was 76.1% and specificity 71.8%. CS had less specificity and sensitivity in predicting epilepsy when focal epilepsies were excluded. Abnormal behavior noted by bystanders, including witnessed unresponsive, unusual posturing, or limb jerking? (Q5) emerged as the most important question for the detection of epilepsy. Compared with other syncope findings, loss of consciousness during prolonged sitting or standing (Q9) emerged as the most important for the detection of syncope.
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