Syncopal attacks in children: Is it cardiac or epilepsy related?

Transient loss of consciousness (TLOC) may be mistaken for other disorders like epilepsy. Our objectives were to identify symptoms that could help differentiate epilepsy from syncope among children with TLOC and to validate previously suggested criteria. We retrospectively reviewed the charts of patients aged 18 years or younger who presented with TLOC attacks from January 2008 to December 2018 at King Saud University Medical City, Riyadh, Saudi Arabia. Symptoms from which epilepsy and syncope could be predicted with high accuracy were included in the previously suggested criteria. The discriminative abilities of current and previous criteria were examined in receiver-operating characteristic analyses. Data from 46 patients, 32 with confirmed epilepsy and 14 with syncope, were included in this analysis. The mean age was 12.1 years (S.D., 4.3 years), and 60.9% of the patients were girls. According to our proposed criteria, the sensitivity, specificity, and accuracy of symptoms in predicting epilepsy were 68.8%, 85.7%, and 73.9%, respectively, and the area under the curve was 0.814 (confidence interval 0.686 to 0.941, P = 0.001). According to previously suggested criteria, the sensitivity, specificity, and accuracy of symptoms in predicting epilepsy were 63.2%, 62.5%, and 63.0%, respectively, and the area under the curve was 0.730 (confidence interval 0.541 to 0.92, P = 0.063). A number of self-reported/observed symptoms can be used to distinguish epilepsy from syncope with high discriminative ability. The current findings still need to be validated in larger, preferably multiple populations before they can be safely relied upon. •To identify symptoms that can best differentiate epilepsy from syncope among pediatric patients with Transient Loss of Consciousness•To validate previously suggested criteria for evaluation of patients who presented with Transient Loss of Consciousness•To detect neurological and cardiac symptoms with highest accuracy rates for detecting epilepsy and syncope