EDUCATION IN HEART
Electrophysiology
Diagnosis and management of patients with blackouts
1 Manchester Heart Centre, Oxford Road, Manchester, UK
2 Greater Manchester Neurosciences Centre, Hope Hospital, Salford, and the David Lewis Centre for Epilepsy, Cheshire, UK
Correspondence to:
Correspondence to:
Dr Adam Fitzpatrick
Manchester Heart Centre, Oxford Road, Manchester M13 9WL, UK; adam.fitzpatrick@cmmc.nhs.uk
Keywords: blackout; transient loss of consciousness; epilepsy; syncope
| The first 150 words of the full text of this article appear below. |
A blackout, or transient loss of consciousness (T-LOC) occurs because there is: a disorder of the circulation—syncope; a disorder of the brain—epilepsy (or other rare neurological condition); a disorder of the psyche—psychogenic seizures.
CAUSES OF BLACKOUTS: EPILEPSY OR SYNCOPE?
It is clear from referral patterns and current care pathways that many doctors assume that T-LOC is usually caused by epilepsy, but in fact syncope is more likely1–3 (table 1
). The majority are cases of reflex syncope, with up to 50% of people suffering reflex syncope during their lives. In most patients this presents as simple fainting, and many sufferers never come to neurological evaluation. However, a very significant number of patients with syncope may be misdiagnosed with epilepsy. This is a common mistake, it damages patients lives, may result in failure to respond to treatment, and may be very dangerous. For example, in the UK only about 4% of patients attending neurological clinics have
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