Transient loss of consciousness and syncope in children and young people: what you need to know

Fifteen-minute consultation: when is a seizure not a seizure? Part 2, the older child

“…Presyncopal symptoms include dizziness, nausea, feeling hot, sudden ‘greying out’, a rushing noise in the ears and vague abdominal discomfort. These symptoms are followed by a sensation of confusion and loss of consciousness 5. Up-rolling of the eyes, urinary incontinence and shaking of limbs can all occur during syncope, potentially causing diagnostic confusion with ES.…”

How to use…the paediatric ECG

“…Readers are referred to recent reviews for a detailed overview 8. There are a number of comprehensive guidelines for management of syncope in adults, such as:

NICE 2010: Transient loss of consciousness in adults and young people 9

…”

“…Each guideline highlights the importance of a detailed medical, family and episode history, and the ECG; the ESC guidelines have a paediatric section which states that the diagnostic evaluation in paediatrics is similar to that in adults, and : ‘Careful personal and family history and standard ECG are most important in distinguishing benign reflex syncope (also including reflex anoxic seizure or breath-holding spells) from other causes.’10 Cardiogenic causes of syncope in the paediatric population account for approximately 5% of cases,8 but these are potentially life threatening (see table 2 and figure 2). …”

Management of reflex anoxic seizures in children

“…Other terminology for RAS includes ‘reflex asystolic syncope’, ‘pallid or white breath-holding spells/attacks’, ‘infantile vasovagal syncope’ and ‘pallid syncopal attacks’. Older children and adults with the same disorder have been diagnosed with ‘convulsive cardioinhibitory neurally mediated syncope’ 1. Reflex asystolic syncope would seem to be the most appropriate alternative term because it describes precisely what occurs in this clinical entity; it also avoids using the word ‘seizure’ that increases the potential to misdiagnose RAS as epilepsy.…”