Functional Syncope in Children and Adolescents: A Retrospective Cohort Study

Area of Science:

• Neurology
• Pediatrics
• Psychosomatic Medicine

Background:

• Functional syncope, also known as psychogenic pseudosyncope, is frequently underdiagnosed in pediatric populations.
• Early recognition and diagnosis are crucial for effective management and improved patient outcomes.

Purpose of the Study:

• To evaluate the diagnostic accuracy of initial neurological consultations for functional syncope in pediatric patients.
• To identify clinical features and diagnostic criteria for functional syncope in children presenting with apparent transient loss of consciousness (a-TLOC).

Main Methods:

• Retrospective review of medical records for pediatric patients (age <19 years) evaluated for a-TLOC and suspected functional syncope between 2006 and 2022.
• Inclusion criteria focused on episodes of a-TLOC with spontaneous recovery, specific clinical presentations, and absence of other medical causes.
• Patients were classified as "definite" or "probable" functional syncope based on the presence of specific diagnostic criteria, including witnessed episodes.

Main Results:

• Out of 31 patients with a-TLOC, 26 were diagnosed with functional syncope (23 females), with ages ranging from 6 to 17 years.
• Episodes were often prolonged (mean 58 minutes) and frequent (daily/weekly in 65%), characterized by eyes closed (71%) and eye flutter (27%).
• At a mean follow-up of 15 months, 29% of patients experienced resolution of episodes, 36% had a >50% decrease, and 36% remained unchanged.

Conclusions:

• Functional syncope in pediatric patients can often be diagnosed during the initial neurological consultation.
• No additional diagnostic testing is typically required for the diagnosis of functional syncope in this population.
• This approach facilitates timely management and reduces the need for extensive investigations.