11. Clinical usefulness of synchronous tilt testing and video-EEG monitoring in patients diagnosed with epilepsy

Abstract

The differential diagnosis of loss of consciousness (LOC) is sometimes difficult due to the possible coexistence of syncope and seizures in the same patient, so that also an expert neurologist can misdiagnose. Our aim was to evaluate the clinical usefulness of synchronous tilt testing and video-EEG monitoring in patients diagnosed with epilepsy. In epilepsy outpatient clinic, we selected 23 patients (47 ± 21 years) divided into: – Group A: 17 (74%) patients newly diagnosed with epilepsy due to LOC with neurological clinical features or EEG epileptiform discharges (N = 10). 8 (47%) patients were given antiepileptic drugs. – Group B: 6 (26%) epileptic patients followed in epilepsy outpatient clinic, suffering of new episodes of LOC with unusual clinical features. 17 tilt testing resulted in clinically relevant episodes (74%). – Group A: 12 patients (52%) had vasovagal syncope, 2 patients (9%) psycogenic episodes. 6 out of 8 patients (75%) discontinued antiepileptic drugs. – Group B: 3 patients (50%) had vasovagal syncope, avoiding the increase of therapy. Synchronous tilt testing and video-EEG monitoring has an unquestionable clinical value for the differential diagnosis of LOC both in epileptic patients and in non-epileptic patients presenting with a doubtful ictal semiology.