Abstracts

Rationale: The correct and unequivocal classification of episodes with a sudden loss of consciousness (LOC) may be very challenging and difficult. time-consuming and expensive video-EEG-monitoring, extensive cardiologic diagnostics or the implantation of an event recorder are frequently used diagnostic techniques. In single cases we made excellent experiences when showing a DVD including different types of epileptic seizures (ES) and non-epileptic seizure-like episodes (SLE) to observers of the LOC. In this study we systematically addressed the diagnostic value of this approach. Methods: 20 patients with an unexplained LOC (12 women, 8 men, median age 37 (22-54)), were included in this study. Observers of an event were shown a DVD including different types of ES and SLE. They had to decide which type of seizure on the DVD was most similar to the observed event. The answer was compared to the results of the clinical evaluations including medical history, EEG, and MRI. Results: In 18 patients video-EEG-monitoring wasn t necessary because observers made a definite classification by means of the DVD which was plausible considering the clinical evaluations (11 syncopes, 5 epilepsies, 2 dissociative seizures). In 2 patients, unconsciousness remained unexplained. In these patients, video-EEG-monitoring revealed epileptic and psychogenic non-epileptic seizures, respectively. Conclusions: Extended third-party-clinical-history by means of a DVD including different types of ES and SLE improves the classification of unexplained loss of consciousness significantly and may be able to reduce the number of video-EEG-monitorings and event recorder implantations.