Frequent episodes of syncope tied to psychogenic etiology in children: Study

Literature states that Syncope is commonest in the adolescent age group with a peak in incidence between 15 to 19 years. Although cardiac causes of syncope are rare, they can be potentially life-threatening. Even a benign syncopal event can generate extreme anxiety. As a result, syncope evaluation often leads to a battery of expensive low-yield tests.

Therefore, Sweta Mohanty and associates from the Department of Pediatric Cardiology, Neurology, and Clinical Neurosciences and Child and Adolescent Psychiatry, Aster CMI Hospital, Bengaluru, Karnataka, India conducted the study to describe the clinical profile of children with syncope.

Hospital records were reviewed for clinical and laboratory details of children presenting with real or apparent syncope. Five diagnostic categories were identified: neurocardiogenic syncope (NCS), psychogenic pseudosyncope (PPS), cardiac, neurological, and indeterminate. A total of 30 children aged 4 to 17 years were included in the study.

The results showed that-

3. The commonest cause of syncope was NCS (63.3%), followed by PPS (13.3%), cardiac (10%), neurological (10%) and indeterminate (3.3%).
4. Exercise, loud noise or emotional triggers and family history was associated with cardiac etiology and electrocardiogram (ECG) was diagnostic in the majority.
5. Children with PPS and cardiac syncope had frequent episodes when compared with other groups.
6. Indiscriminate antiepileptic use was found in 5 children, including two cardiac cases.

Hence, the authors concluded that "frequent recurrences of syncope may suggest PPS or cardiac cause. Cardiac etiology may be readily identified on history and ECG alone."

This study has the limitation of being a retrospective study, with a small sample size. However, a detailed history is of paramount importance in making the diagnosis in syncope and cases of syncope need an ECG to rule out potentially life-threatening cardiac causes, they further added.