Tilt Table Test & Misdiagnosis of Epilepsy (P02.169)

Abstract

Objective: To discuss four cases, where diagnosis of epilepsy was missed secondary to an “abnormal tilt table test.” Background Although patho-physiologically distinct, syncope and seizures share clinical characteristics which may make diagnosis difficult. Syncope may be associated with seizure-like motor manifestations, and seizures may be complicated by cardiac arrhythmia and loss of consciousness. Over the last decade, upright tilt table testing has emerged as an important diagnostic method for the identification of individuals whose syncope is likely to be neurocardiogenic in origin. Design/Methods: We studied all the patients referred to our epilepsy center for evaluation of loss of consciousness between ages 18 to 65 years. This included all outpatient referrals and direct admits to the video-EEG monitoring (VEEM) unit over one year. The diagnosis of epilepsy was made based on the presence of strong interictal EEG abnormalities, or ictal EEG abnormality correlating with the events to suggest the diagnosis of epilepsy. Results: We diagnosed four patients with epilepsy, who were previously diagnosed with syncope based on “abnormal tilt-table test.” Two patients were diagnosed based on outpatient EEG, during which one patient had clinical and electrographic seizure and the other one had strong evidence of interictal generalized spikes. The remaining two patients had prolonged VEEM, and multiple events were captured, which confirmed the diagnosis of epilepsy. At present time, three out of four patients are seizures-free with appropriate antiepileptic drugs (AEDs), and one has improved dramatically with addition of AEDs. Conclusions: Although the vast majority of patients that neurologist encounters in day to day life with possible syncope truly suffer from syncope, a small fraction of them may have epilepsy. The correct diagnosis can often be made if emphasis is put on adequate history taking instead of overemphasis on unnecessary ancillary testing. Disclosure: Dr. Jain has nothing to disclose. Dr. Bozorg has nothing to disclose.