Syncope in Pediatric Practice

Review Article
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Abstract

Syncope is defined as a sudden, self-limited loss of consciousness and postural tone followed by spontaneous and complete recovery without any neurological sequelae. It is one of the most common paroxysmal disorders in children and adolescents. The three major causes of syncope in children are neural, cardiovascular and other non-cardiovascular causes. The common unifying mechanism is transient global hypoperfusion of the brain. The diagnosis is primarily clinical and objective laboratory investigations add little to the diagnosis in children especially in neurocardiogenic subtype. Specific management depends on the underlying cause of syncope in children. For cardiac causes, management includes early referral to the pediatric cardiology specialist. When paroxysmal non-epileptic events are suspected, child psychology or psychiatry consultation should be sought to identify the stressors and counseling. For neurocardiogenic syncope, the main objective of treatment is to prevent recurrent events to improve the quality of life, psychological stress and school absenteeism by behavior and lifestyle modifications followed by drugs in refractory cases. The prognosis is excellent for neurocardiogenic syncope and is variable based on the underlying pathology in cardiogenic cases. As syncope is not a disease in itself but a symptom of an underlying disorder; hence, all children with syncope require assessment to exclude an underlying life-threatening cardiac or non-cardiac disorder.

Keywords

Syncope Children Vasovagal Cardiogenic Neurogenic 

Notes

Contributions

AGS and PS: Draft of the manuscript and final review of the manuscript for intellectual content. PS will act as guarantor for the paper.

Compliance with Ethical Standards

Conflict of Interest

None.

Source of Funding

None.

References

  1. 1.
    Feit LR. Syncope in the pediatric patient: diagnosis, pathophysiology, and treatment. Adv Pediatr. 1996;43:469–94.Google Scholar
  2. 2.
    Fischer JW, Cho CS. Pediatric syncope: cases from the emergency department. Emerg Med Clin North Am. 2010;28:501–16.CrossRefPubMedGoogle Scholar
  3. 3.
    Friedman NR, Ghosh D, Moodley M. Syncope and paroxysmal disorders other than epilepsy. In: Swaiman KF, Ashwal S, Ferriero DM, Schor NF, editors. Swaiman's Pediatric Neurology: Principles and Practice. 5th ed. China: Elsevier, Inc; 2012. p. 906–10.Google Scholar
  4. 4.
    Kaufman H. Evaluation of the patient with syncope. In: Robertons D, Biaggioni I, Burnstock G, editors. Primer on the autonomic nervous system. 2nd ed. San Diego: Elsevier Academic Press; 2004.Google Scholar
  5. 5.
    Massin MM, Bourguignont A, Coremans C, Comte L, Lepage P, Gerard P. Syncope in pediatric patients presenting to an emergency department. J Pediatr. 2004;145:223–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Kanjwal K, Calkins H. Syncope in children and adolescents. Cardiac Electrophysiol Clin. 2013;5:443–55.CrossRefGoogle Scholar
  7. 7.
    Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in children and adolescents. J Am Coll Cardiol. 1997;29:1039–45.CrossRefPubMedGoogle Scholar
  8. 8.
    Crompton DE, Berkovic SF. The borderland of epilepsy: clinical and molecular features of phenomena that mimic epileptic seizures. Lancet Neurol. 2009;8:370–81.CrossRefPubMedGoogle Scholar
  9. 9.
    Moodley M. Clinical approach to syncope in children. Semin Pediatr Neurol. 2013;20:12–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Benbadis SR, Chichkova R. Psychogenic pseudosyncope: an underestimated and provable diagnosis. Epilepsy Behav. 2006;9:106–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Thijs RD, Bloem BR, van Dijk JG. Falls, faints, fits and funny turns. J Neurol. 2009;256:155–67.CrossRefPubMedGoogle Scholar
  12. 12.
    Wieling W, Shen W. Syncope: approach to management. 3rd ed. Baltimore: Lippincott, Williams and Wilkins; 2008.Google Scholar
  13. 13.
    Prodinger RJ, Reisdorff EJ. Syncope in children. Emerg Med Clin North Am. 1998;16:617–26, ix.Google Scholar
  14. 14.
    Grubb BP, Gerard G, Wolfe DA, et al. Syncope and seizures of psychogenic origin: identification with head-upright tilt table testing. Clin Cardiol. 1992;15:839–42.CrossRefPubMedGoogle Scholar
  15. 15.
    Kapoor WN. Diagnostic evaluation of syncope. Am J Med. 1991;90:91–106.CrossRefPubMedGoogle Scholar
  16. 16.
    Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines, and the Heart Rhythm Society. Circulation. 2017;136:e60–122.CrossRefPubMedGoogle Scholar
  17. 17.
    Strieper MJ. Distinguishing benign syncope from life-threatening cardiac causes of syncope. Semin Pediatr Neurol. 2005;12:32–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Johnsrude CL. Current approach to pediatric syncope. Pediatr Cardiol. 2000;21:522–31.CrossRefPubMedGoogle Scholar
  19. 19.
    Massin M. Neurocardiogenic syncope in children : current concepts in diagnosis and management. Paediatr Drugs. 2003;5:327–34.CrossRefPubMedGoogle Scholar
  20. 20.
    Freeman R. A treatment for neurally mediated syncope? (Don't) Hold your breath. Ann Neurol. 2008;63:265–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Stewart JM. Midodrine for the treatment of vasovagal syncope (simple faint). J Pediatr. 2006;149:740–2.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2017

Authors and Affiliations

  1. 1.Pediatric Neurology Unit, Department of PediatricsPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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