[Syncope : epidemiology, definition, classification, pathophysiology and prognosis]

Association between Syncope and the 6-Month Incidence of Ischemic Stroke, Arrhythmia, Brain Tumor, Epilepsy, and Anxiety Disorder

OBJECTIVES

the aim of the present study is to investigate the associations between syncope and subsequent diagnoses of brain tumor, cardiac arrhythmia, stroke/transient ischemic attack (TIA), epilepsy, and anxiety disorder in a large outpatient population in Germany.

METHODS

This retrospective cohort study uses data from the Disease Analyzer database (IQVIA). Adults who received syncope diagnosis from one of 1284 general practices between January 2005 and December 2021 (index date) were included and matched (1:1) to individuals without syncope diagnosis using a propensity score based on age, sex, the number of consultations during the follow-up period (up to 6 months), and defined co-diagnoses documented within 12 months prior to and on the index date. Finally, associations between syncope and subsequent outcome diagnoses were investigated using multivariable logistic regression models.

RESULTS

Data related to 64,016 patients with and 64,016 patients without syncope (mean age 54.5 years, 56.5% female) were available. In total, 6.43% of syncope patients and 2.14% of non-syncope patients were diagnosed with one of the five outcome diagnoses within 6 months of the index date. There was a positive and significant association between syncope and incidences of ischemic stroke/TIA (OR = 2.83, 95% CI = 2.41-3.32), arrhythmia (OR = 3.81, 95% CI = 3.44-4.18), brain tumor (OR = 4.24, 95% CI = 2.50-7.19), epilepsy (OR = 5.52, 95% CI = 4.27-7.14), and anxiety disorder (OR = 1.99, 95% CI = 1.79-2.21).

CONCLUSIONS

Syncope is significantly associated with an increased risk of subsequent ischemic stroke/TIA, cardiac arrhythmia, brain tumor, epilepsy, and anxiety disorder. Nevertheless, the cumulative incidences for all five diagnoses are very low.

Psycho-socio-clinical profiles and quality of life in seizure disorders: A cross-sectional registry study

OBJECTIVE

This prospective study aimed at comparing quality of life (QoL) and psycho-socio-clinical profiles between patients with epilepsy, psychogenic nonepileptic seizures (PNES), and syncope. We also intended to identify predictors of QoL in these three seizure disorders.

METHODS

A total of 245 inpatients (epilepsy n = 182, PNES n = 50, syncope n = 13) from a tertiary epilepsy clinic were included. Information on QoL as well as on psychological, sociodemographic, and clinical profiles was retrieved using questionnaires and medical records. Group comparisons on QoL and psycho-socio-clinical profiles were performed via analyses of variance, chi-square tests, and related post hoc tests. Predictors of QoL in epilepsy and PNES were determined using general linear modeling, which was not possible for syncope due to a small sample size.

RESULTS

Patients with epilepsy, PNES, and syncope reported levels of QoL impairment that did not differ significantly between groups (p = 0.266). However, there were significant group differences regarding sex distribution (p < 0.001), seizure disorder duration (p = 0.004), seizure frequency (p = 0.019), current treatment with antiseizure medications (ASM) (p < 0.001), number of current ASM (p < 0.001), and adverse ASM events (p = 0.019). More depressive symptoms (p = 0.001), more adverse ASM events (p = 0.036), and unemployment (p = 0.046) (in this order) independently predicted a diminished QoL in epilepsy. For PNES, more depressive symptoms were the only independent predictor of lower QoL (p = 0.029).

CONCLUSIONS

Patients with epilepsy, PNES, and syncope experience similarly diminished QoL and show a general psycho-socio-clinical burden with a specific pattern for each seizure disorder diagnosis. Although clinical aspects play an undisputed role for QoL in epilepsy, the psychosocial aspects and consequences are equally, or for PNES probably even more, meaningful. A comprehensive approach to research and treatment of seizure disorders seems mandatory to increase QoL for these patients. More research on QoL in syncope is needed.

[Syncope in children and adolescents: are the current guidelines being followed?]

BACKGROUND

Syncope in childhood and adolescence is frequent and in most cases benign. A thorough history taking, complete physical examination, electrocardiography and further diagnostic work-up as indicated should rule out possible cardiac syncope.

OBJECTIVE

To evaluate whether the diagnosis of syncope was performed according to the currently valid S2k guideline.

MATERIAL AND METHODS

Retrospective study (January 2015-December 2017), University Children's Hospital of Saarland, Homburg, Germany. All patients aged 1-18 years presenting with the primary complaint of syncope were included.

RESULTS

In this study 262 patients presented with a history of syncope (161 female (61.5%), 101 male (38.5%), median age 12.5 ± 3.9 years). Of these, 183 (69.8%) were reflex syncopes, 36 (13.7%) presyncopes, 35 (13.4%) undefined and 8 (3.1%) cardiac syncope. Out of 262 patients, 43 (16.4%) were diagnosed in accordance with the published guidelines and 13/43 (30.2%) correctly received further diagnostic work-up. In 219/262 patients (83.6%) basic diagnostic testing was not sufficient and 135/219 (61.6%) were submitted to further unnecessary diagnostic tests.

CONCLUSION

Better adherence to the syncope guidelines bears the potential to avoid unnecessary and costly auxiliary medical tests while correctly diagnosing patients with syncope.

[Transient loss of consciousness : Algorithm for the (differential) diagnosis of syncope at emergency department]

Transient loss of consciousness (TLoC) is a common complaint leading to presentation at the emergency department. This comprises a heterogeneous group of disorders including cerebral events, metabolic disturbances, intoxication, psychogenic patterns or any form of syncope. While many causes are benign and self-limited not requiring extensive in-hospital evaluation, others are potentially severe. The optimal evaluation of patients with TLoC/syncope follows a risk-adapted diagnostic algorithm in order to exclude life-threatening conditions and to identify those with high risk for further deterioration like structural heart diseases requiring further diagnostic evaluation. Low-risk patients can be discharged without further extensive diagnostic work up. This article presents an algorithm for structured, evidence-based care of the syncope patient in accordance with the recently launched "2018 ESC guidelines for the diagnosis and management of syncope" in order to ensure that patients requiring hospitalization are managed appropriately and those with benign causes are discharged safely. The English version of this algorithm is available at the end of the article under "Supplementary Material".