Usability of the head upright tilt test for differentiating between syncopal and seizure-like events in children

The common diagnosis of loss of consciousness and clonic movements in children is seizure or epilepsy, but in a number of patients these symptoms could also be due to syncope. Over interpreted electroencephalography is misleading in a number of patients; therefore, in addition to a detailed and thorough history, a reliable test is needed to differentiate between these conditions. The aim of the study was to evaluate the utility of the head upright tilt test to differentiate between seizure-like events and syncope in children. A chart review descriptive study was conducted in a tertiary medical center in Ahvaz, Iran. We selected sixteen children (nine boys and seven girls) with convulsions of any type who were first diagnosed as epileptic based on the event description by their parents or caregivers to undergo the head upright tilt test. The main findings were the reproduction of previously presyncopal or syncopal symptoms in the tilted position. Fourteen children showed positive results after conducting the head upright tilt test, and their heart rates were significantly decreased compared to baseline at the onset of the syncopal or presyncopal manifestations. Systolic and diastolic blood pressures were significantly reduced in patients with positive results. In three children who initially had negative head upright tilt tests, intravenous isoproterenol was administered, and all three showed presyncopal and syncopal symptoms. The results indicate that the head upright tilt test could differentiate presyncopal and syncopal events in children who present with seizure-like movements but their history has clues for conclusive syncope.