Prolonged implantable electrocardiographic monitoring indicates a high rate of misdiagnosis of epilepsy--REVISE study

Syncope, epilepsy, and psychogenic pseudo-syncope are the most common causes of transient loss of consciousness (T-LOC or blackout). All can present with similar features, including abnormal limb movements. It is reported that somewhere between 13 and 42% of patients with 'epilepsy' may be misdiagnosed. A UK Parliamentary working group found that at least 74 000 English patients are misdiagnosed with epilepsy, and taking antiepileptic drugs. The likely alternative diagnosis is 'convulsive' syncope, mimicking an epileptic seizure. We hypothesized that many patients misdiagnosed with epilepsy have convulsive reflex syncope, and that prolonged electrocardiographic (ECG) monitoring with an implantable ECG recorder (ILR) would show reflex cardioinhibition during T-LOC. This would respond to permanent pacing and allow antiepileptic drugs to be withdrawn. We also aimed to evaluate tilt testing and other tests done in these patients.