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T-LoC and Syncope - What is the Problem?

Misleading Symptoms

Despite the fact that syncope or unexplained loss of consciousness accounts for 3-5% of emergency department visits and 1-3% of hospital admissions, the diagnosis of syncope can be difficult because of its periodic unpredictable nature.1

  • Patients with syncope are often admitted to hospital and undergo expensive and repeated investigations, many of which do not provide a definite diagnosis2
  • Syncope and collapse is the 6th commonest reason for acute hospital attendance of over 65-year olds (average length of stay: 5-17 days) 3

In particular, syncope can appear similar to an epileptic seizure and as a result it is often confused with generalised epilepsy. 2,4

  • Epilepsy affects less than one percent of the population5
  • It is estimated that over a third of patients diagnosed with epilepsy may have been misdiagnosed1

Reaching a correct diagnosis and ruling out epilepsy can be a lengthy process.

  • Doctors have to rely on second-hand descriptions of the episodes from bystanders, who are usually lay observers
  • There are a limited number of heart rhythm specialists: in the UK there are fewer than 70 dedicated heart rhythm specialists6 – less than one for every ten thousand sufferers2 – and only 350 neurologists for the whole country3

References

  1. European Society of Cardiology, Guidelines on Management (Diagnosis and Treatment) of Syncope, Update 2004 http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/syncope…. Last accessed 6th Nov 2008
  2. Department of Health National Service Framework. Coronary heart disease. Chapter 8. Arrhythmias and sudden cardiac death. https://www.gov.uk/government/publications/quality-standards-for-coronary-heart-disease-care Last accessed 22 July 2013
  3. R. A. Kenny et al, Impact of a dedicated syncope and falls facility for older adults on emergency beds. Age Ageing 2002; 31:272-5
  4. Fitzpatrick, A; Cooper P. Diagnosis and Management of Patients with Blackouts. Heart 2006; 92: 559-568
  5. Smith, D, Defalla B.A. and Chadwick D.W. The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic Q J Med 1999; 92: 15-23
  6. Petkar, S., Jackson, M., Fitzpatrick, A. Management of blackouts and misdiagnosis of epilepsy and falls. Royal College of Physicians Journal : vol 5 : September/October : Conference reports