Recommendations

The Australia and New Zealand Child Neurology Society

The Australia and New Zealand Child Neurology Society (ANZCNS) is a collaborative group of medical professionals working in the field of paediatric neurology or in allied neurosciences who are working to advance the science of paediatric neurology and advocate for improved care for young people with neurological disorders.

5.
Do not routinely perform electroencephalographs (EEGs) for children presenting with syncope (fainting).

Studies have found that the incidence of epileptiform discharges (i.e. distinctive EEG patterns associated with epileptic disorders) in patients with syncope is roughly similar to its incidence among healthy subjects, and that therefore EEG has very low diagnostic yield among these patients. Moreover, clinical criteria have been formulated that can differentiate syncope from seizures with very high sensitivity and specificity.

Thus, guidelines recommend that an EEG should not be performed if syncope is the most likely cause of the transient loss of consciousness.

Supporting evidence
  • Abubakr A, Wambacq I. The diagnostic value of EEGs in patients with syncope. Epilepsy Behav 2005; 6(3):433-4.
  • Dantas FG, Cavalcanti AP, Maciel BDR, et al. The role of EEG in patients with syncope. J Clin Neurophysiol 2012; 29(1):55-7.
  • Linzer M, Yang EH, Estes NAM III, et al. Diagnosing syncope. Part 1: value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med 1997; 126(12):989-96.
  • Poliquin-Lasnier L, Moore FGA. EEG in suspected syncope: do EEGs ordered by neurologists give a higher yield? Can J Neurol Sci 2009; 36(6):769-73.
  • Sheldon R, Rose S, Ritchie D, et al. Historical criteria that distinguish syncope from seizures. J Am Coll Cardiol 2002; 40(1):142-8.
  • Moya A, Sutton R, Ammirati F, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; (21):2631–71.
How this list was made How this list was made

Following deliberations, the ANZCNS Board determined to investigate the evidence for nine priority recommendations regarding low-value clinical practices in paediatric neurology. An evidence review was developed for these recommendations and served as the basis for an online survey sent to all ANZCNS members asking respondents if they agreed, disagreed or were unsure if these recommendations were evidence based, undertaken in significant numbers, and important in terms of reducing patient harm and unnecessary healthcare expenditure. Based on survey responses, each of the nine was assigned a score and ranked accordingly. Based on this information and a final evidence review, these top 5 recommendations were chosen.


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