Abstracts

RATIONALE:_The semiology of simple syncope is distinct from that of epileptic seizures. The author noted several patients who had history most consistent with complex partial seizures, but had syncope that was associated with apparent psychogenic behavioral abnormalities. METHODS:_Retrospective review identified 12 patients with psychogenic elaboration of syncope, among patients referred to an academic epilepsy practice for refractory complex partial seizures. Detailed histories of habitual events were obtained before diagnostic studies. Habitual events were recorded with electrocardiographic tilt table testing (7 patients) or electroencephalographic-video monitoring with electrocardiography (5 patients). RESULTS:_History: Each patient reported an habitual aura, which included lightheadedness in 7 patients, and dTja vu or other psychic symptoms in the others. In each case witnesses of the events reported a fall with less than 1 minute of flaccidity and unresponsiveness, followed by confusion and abnormal movements briefly or for up to one hour. In each case the patient reported postictal lethargy, and amnesia for the event. Electrophysiological diagnosis: In each case behaviorally typical syncope was associated with bradycardia, but was followed by a 5- to 45-minute period of agitation or confusion, with diminished responsiveness. When available, EEG showed generalized slowing during syncope, which returned rapidly to normal baseline activities during post-syncope behavioral abnormalities. Therapy: Recurrent vasodepressor syncope was abolished with beta-blockers and increased oral hydration in 8 patients, and with second-line therapies in the others. None had periods of agitation or confusion after syncope ceased. CONCLUSIONS:_Electrophysiological diagnosis of specific types of non-epileptic seizures may support effective therapy, in addition to supporting avoidance of inappropriate antiepileptic therapy. Psychogenically elaborated syncope may be highly responsive to standard therapies of recurring vasodepressor syncope, but may be difficult to distinguish from epileptic seizures by history alone.