Application of a Head-Up Tilt Table Test in Differentiation Between Epilepsy and Syncope in Children

Background: Distinguishing between seizure and neurally mediated syncope is challenging because of similar consequences and medical history. A head-up tilt test (HUTT) is a non-invasive, simple, and easy test to distinguish between epilepsy and syncope besides detailed history taking. Objectives: This study aimed to differentiate between epileptic events and reflex syncope (any different type of syncope) using the head-upright tilt test. Methods: We studied 59 patients (37 boys and 22 girls) between 4 to 18 years old (mean age, 10.5 ± 3.7 years) with a previous diagnosis of seizure who did not respond well to treatment. All patients underwent HUTT, and the test was positive in 26 patients. There were no significant differences in sex, age, provocative factors, associated syndrome, and family history between negative and positive groups. Results: There was a history of actual syncope in 26.9% of the positive tilt test group compared to 15.15% of the negative test group. Also, there was a positive family history of syncope in the positive tilt test group. Among 26 patients with a positive tilt test, 17 were diagnosed with vasovagal syncope (VVS) vasodepressor type and 9 with mixed type. Antiepileptic drugs were tapered for patients diagnosed with VVS, and they did not show any seizures after 18 ± 6 months of follow-up. Overemphasizing positive family history and inattention to history taking are 2 crucial factors leading to the misdiagnosis of epilepsy. Conclusions: Our study showed that HUTT is a non-invasive test that can be useful, especially for early and proper diagnosis in children with refractory epilepsy.