Tilt Table Testing in patients with suspected epilepsy

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Rangel I (Author) Other; Freitas J (Author) Other; Sousa A (Author) Other; Correia AS (Author) Other; Lebreiro A (Author) Other; Paiva M (Author) Other; Sousa C (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Heart Journal

Pages: 828-828

ESC Congress 2012

Munich, 25 a 29 de Agosto de 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Background: Around 20% to 30% of epileptic patients may have been misdiagnosed and neurocardiogenic syncope (NCS) is probably a frequent mistaken cause. Objective: We sought to assess the role of head up tilt testing (HUTT) in diagnosing NCS in patients referred with refractory epilepsy and the role of modifying therapeutic orientation. Methods: We retrospectively analysed clinical records of 107 patients with previous epilepsy and medicated with antiepileptic drugs, who were referred for HUTT, in the period from January 2000 to December 2010. They were subsequently followed-up with a telephone interview, about their clinical follow-up, including therapeutic orientation and recurrence of symptoms. Results: Among all, 73 (68%) patients were women with a mean age of 38±17 years. HUTT was positive in 67 (63%) patients (vasodrepressor response in 36%, cardioinhibitory in 3%, mixed in 24%). Follow-up data were available in 94 (88%) patients, with a mean follow-up period of 72 months. Thirty-three (35%) patients previously diagnosed with epilepsy were found to be misdiagnosed (positive HUTT and clinical features not consistent with epilepsy). Twenty-one (22%) patients had dual diagnosis of NCS and epilepsy (HUTT positive but presence of clinical features supporting epilepsy). There was no significant difference in the type of HUTT response between the misdiagnosed group and the dual diagnosis group (p>0,05). Misdiagnosed patients (isolated NCS with typical clinical reproduction at HUTT) stopped taking antiepileptic medication, 15% of them received new pharmacological treatment (midodrine or B-blocker) and most were reassured and advised to increment salt and water intake and perform physical countermanouvres. Syncope recurrence was reported in 57% of the patients. No relevant difference between positive and negative HUTT groups (49% vs 69%; p>0,05) was observed but it was significantly lower in the misdiagnosed group of patients (42% vs 64%; p=0.037). Conclusion: NCS is frequently an important cause of epilepsy misdiagnosis. HUTT is often crucial to make an accurate diagnosis and to select the appropriate treatment in patients presenting with transient loss of consciousness to reduce recurrence. Diagnostic overlap of epilepsy and NCS is not uncommon, suggesting that electroencephalographic monitoring during HUTT may have an important role in patients manifesting recurring undiagnosed convulsive blackouts.

Language: English

Type (Professor's evaluation): Scientific

Notes: Rangel I, Freitas J, Sousa A, Correia AS, Lebreiro A, Paiva M, Sousa C, Maciel MJ. Tilt Table Testing in patients with suspected epilepsy. Eur Heart J 2012; 33 (Abstract Suppl): 828