RT Journal Article
SR Electronic
T1 Tilt-induced vasovagal syncope and psychogenic pseudosyncope
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 2006
OP 2010
DO 10.1212/WNL.0000000000002184
VO 85
IS 23
A1 Blad, Helene
A1 Lamberts, Robert Jan
A1 van Dijk, J. Gert
A1 Thijs, Roland D.
YR 2015
UL http://n.neurology.org/content/85/23/2006.abstract
AB Objective: To describe the combination of tilt-induced vasovagal syncope (VVS) and psychogenic pseudosyncope (PPS) and aid its clinical recognition.Methods: We identified people with tilt-induced VVS/PPS from 2 tertiary syncope referral centers. For each case, 3 controls with tilt-induced VVS were selected at random from the same center. Clinical characteristics were compared between both groups adjusting for multiple comparisons.Results: Of 1,164 tilt-table tests, 23 (2%) resulted in VVS/PPS; these 23 cases were compared with 69 VVS controls. VVS and PPS coincided more often than chance would predict: 2% vs 0.6%, p < 0.001. Typical VVS prodromes and triggers were reported in all people with VVS/PPS and in controls with VVS. Attack frequency was significantly higher in the VVS/PPS (2 per month, range 0.1–60) than in the VVS group (0.25 per month, range 0.02–4; p < 0.001). Delayed recovery of consciousness was more frequently reported in the VVS/PPS group (likelihood ratio [+LR] 8.14, 95% confidence interval [CI] 3.94–16.84), as well as episodes without prodromes (+LR 5.57, 95% CI 2.53–12.26), atypical triggers (+LR 5.00, 95% CI 2.04–12.24), eye closure (+LR 3.75, 95% CI 1.68–8.35), and apparent loss of consciousness >1 minute (+LR 2.86, 95% CI 1.98–4.13).Conclusions: VVS/PPS presents with a complex phenotype. High attack frequency, delayed recovery of consciousness, apparent loss of consciousness >1 minute, ictal eye closure, atypical triggers, and the absence of prodromes may serve as indicators that PPS coincides with VVS.AED=antiepileptic drug; BP=blood pressure; CI=confidence interval; HR=heart rate; LR=likelihood ratio; LUMC=Leiden University Medical Centre; PNES=psychogenic epileptic seizure; PPS=psychogenic pseudosyncope; SEIN=Stichting Epilepsie Instellingen Nederland; TLOC=transient loss of consciousness; VVS=vasovagal syncope