Transient loss of consciousness in children: Syncope or epileptic seizure?

Abstract

Background & Objective: Transient loss of consciousness (TLOC) is often benign from syncope but may be due to epileptic seizure. In this study, we aimed to evaluate the clinical differences between TLOC from epileptic seizures and syncope.

Methods: The medical records of 300 children with TLOC were analyzed retrospectively. Age, sex, clinical symptoms, trigger factors, laboratory findings, ECG, ECHO, EEG and neuroimaging findings, as well as the causes of TLOC were reviewed.

Results: Out of the 300 children admitted with TLOC, 288 (96%) were diagnosed as syncope. Of these patients, 231 (77%) were diagnosed as vasovagal syncope, 19 (6.3%) as orthostatic hypotension, and 38 (12.7%) as unclassifiable syncope. Twelve (4.2%) patients were diagnosed with epilepsy. Patients with epilepsy showed significantly higher rates of collapse and eye deviation during TLOC, as well as occurring in sitting and supine position (p=0.012, p=0.039, p=0.03 respectively).

Conclusion: For a differential diagnosis, TLOC accompanied by collapse, eye deviation and occurrence in sitting or supine position are suggestive of epilepsy.