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Explaining blackouts

A checklist launched by STARS (Syncope Trust And Reflex anoxic Seizures) will help patients and their doctors determine the cause of unexplained loss of consciousness - blackouts. Up to half the UK population will suffer blackouts at some stage in life and these are most likely to be due to syncope, a little-known, cardiovascular problem. Syncope often goes unrecognised or misdiagnosed because its clinical features mimic those associated with epilepsy. Epilepsy affects less than 1% of the population, contrasting dramatically with the likelihood of a syncopal episode.

Although blackouts are more likely to be the result of a cardiovascular condition, it is estimated that up to 150,000 UK epilepsy patients, predominantly children, have been misdiagnosed. The misdiagnosis of epilepsy is estimated to cost the NHS approximately £180m each year.

Despite being the sixth most common reason for visits to the emergency department and responsible for 1% of all hospital admissions in the UK, the diagnosis of syncope can be difficult because patients may have fully recovered upon admission. Doctors have to rely on secondhand descriptions of the episodes from bystanders, who are usually lay observers. In addition, there are fewer than 70 dedicated heart rhythm specialists in the UK - less than one for every 10,000 sufferers - and only 350 neurologists for the whole country. As a result, ruling out epilepsy and reaching a correct diagnosis can be a lengthy process.

"To help reach a correct diagnosis, it is vital that patients provide as much accurate information as possible to their doctor" explains Dr Adam Fitzpatrick, a cardiologist and heart rhythm specialist from the Manchester Heart Centre. "This checklist helps patients structure the recollection of their blackout and provide clinicians with valuable insights to aid accurate diagnosis and treatment."

The checklist prompts patients to prepare before talking to their doctor about a blackout:

  • Recollecting symptoms and triggers before the blackout and their frequency.
  • Asking friends and family who witnessed the blackout to describe the episode from trigger to recovery.
  • Learning about family history of blackouts or any unexplained sudden deaths in the family history.

Trudie Lobban, founder and chief executive of STARS notes that, "When patients are equipped with important information they can help their doctor better understand the symptoms and nature of their blackout. This can help avoid a long list of referrals, freeing vital time and resources and ensure an accurate diagnosis and subsequent treatment for the patient."