The Utility of Head Up Tilt Test with Video Electroencephalography in Children with Recurrent Loss of Consciousness

Aim: We aimed to detect the utility of head up tilt test with video electroencephalography (EEG) in children with unexplained, recurrent loss of consciousness episodes. Method: Video EEG were recorded during the head up tilt test. The test was terminated if syncope or presyncope with 30% decrease in heart rate and/or systolic blood pressure occurred. Regarding encephalography, average amplitudes and frequencies at the baseline, tilt up position, presyncope, syncope and post-syncope period were evaluated from frontal, temporal and parieto-occipital areas. Results: There were 29 children (23 girl, 6 boy), with a mean age 13.83±3.3 years who had at least two syncopal attacks. Head up tilt test combined with video EEG was diagnostic in 12/29 patient (41.4%). 8/12 of the patients developed syncope attack and 4/12 of the patients developed presyncope attacks. Four (33.3%) of the patients with syncope attack had associated involuntary movements (3 vasodepressor, 1 mixed type). In the tilt positive group, there were significant differences in the amplitudes of frontal regions between the baseline and presyncope period (p=0.016 and 0.027, right and left hemispheres, respectively). There were also significant differences in the amplitudes of frontal and parieto-occipital regions and in the frequencies involving the bilateral parietooccipital regions of the baseline and syncope period (p<0.05). In conclusion, head up tilt test with video electroencephalography is a useful evaluation for children with recurrent vasovagal syncopes and allows systematic description of electroencephalographic abnormalities during the presyncopal or syncopal events.