The usefulness of the head.up tilt test in patients with suspected epilepsy

• Type: Article in International Scientific Journal
• Date: 2014

Authors

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

Journal

Title: Seizure : the journal of the British Epilepsy Association

Vol. 23 No. 5

Pages: 363-370

ISSN: 1059-1311

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 11 Citations

ISI Web of Science

Scopus - 12 Citations

Pubmed / Medline

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Authenticus ID: P-009-H71

DOI: 10.1016/j.seizure.2014.02.004

Abstract (EN): It is estimated that approximately 20-30% of patients diagnosed with epilepsy have been misdiagnosed, and neurocardiogenic syncope (NCS) might frequently be the real cause of transient loss of consciousness (TLOC) episodes. We assessed the role of the head-up tilt test (HUTT) in patients previously diagnosed with refractory epilepsy to evaluate the ability of this test to correctly diagnose patients with NCS. METHOD: We retrospectively analysed the clinical records of 107 consecutive patients with a previous diagnosis of refractory epilepsy that were taking antiepileptic drugs and who were referred for HUTT between January 2000 and December 2010. During the subsequent follow-up, we recorded the treatments performed and the recurrence of symptoms. RESULTS: Complete follow-up data were available for 94 (88%) patients, and the mean follow-up period was 80±36 months. The HUTT was positive in 54% of patients. Thirty-one (33%) patients were misdiagnosed with epilepsy, and 20 (21%) patients had a dual diagnosis of NCS and epilepsy. The recurrence of TLOC was reported in 55% of the patients, but it was significantly lower in the misdiagnosed group (42% versus 64%; P=0.039). CONCLUSION: NCS is an important cause of epilepsy misdiagnosis. The HUTT is often critical for making an accurate diagnosis and subsequently selecting the appropriate treatment for patients presenting with TLOC. The diagnostic overlap between epilepsy and NCS is not uncommon, suggesting that electroencephalographic monitoring during a HUTT may play an important role in diagnosing patients with recurrent, undiagnosed TLOC episodes.

Language: English

Type (Professor's evaluation): Scientific

Notes: Rangel I, Freitas J, Correia AS, Sousa A, Lebreiro A, Sousa C, Maciel MJ, Azevedo E. The usefulness of the head.up tilt test in patients with suspected epilepsy. Seizure 2014; 23 (5): 367-370.