A review of 35 cases of vasovagal syncope in children

Abstract

  Objective: Vasovagal syncope (vasovagal syncope ; VVS) is induced by long-term standing and stress and involves the dysregulation of autonomic nerves. Because there are few reported cases of pediatric VVS, its clinical presentation remains unclear and it is challenging to diagnose on the basis of the objective criteria. This study aimed to clarify the clinical presentation and the objective criteria of pediatric VVS. Methods: We retrospectively examined 35 pediatric patients (90 syncopal episodes in total) at our medical department between April 2005 and March 2018 who were suspected of having VVS on the basis of clinical symptoms. Results: The age of onset ranged from 5 to 15 years (median 11 years), and the number of girls was approximately twice as many as the boys. A total of 60 syncopal episodes (67%) occurred in school, including 54 (60%) that occurred while standing for a long period during ceremonies and music classes. Eleven syncopal episodes (31%) were accompanied with convulsions, and seven patients (20%) were injured because of falling. Of the 35 cases, a total of 14 (40%) were confirmed as VVS through testing, including active standing test (9 of 35 cases) and head-up tilt test (HUT) (5 out of 8 cases). Recurrence occurred in 27 cases (77%), including 20 cases (57%) in which recurrence occurred within a year. Midodrine hydrochloride was effective for syncope accompanied by dizziness/lightheadedness. Conclusion: The diagnostic rate of VVS can be improved by a combination of standing test and HUT. Pediatric patients with VVS are more prone to recurrence than adult patients and are at appreciable risks in daily life, such as injuries due to falls ; therefore, active therapeutic intervention is desirable.