Coordinating Panel on Rare Neurological Diseases Clinical neurophysiology

Tilt table testing in neurology and clinical neurophysiology

Syncope is a frequent clinical presentation in neurology departments. This clinical event, situated at the border between neurology and cardiology, is sometimes neglected by both specialties. History taking and clinical examination is in many occasions enough to decide about the most probable cause of a transient loss of consciousness (TLOC). When further examinations are needed, the most convenient is the tilt table test (TTT), which indications, physiological bases and pathophysiological principles in the most important syndromes presenting with TLOC are described in this selected breakthrough article (Saal et al., 2016). 

Syncope is a frequent clinical presentation in neurology departments. This clinical event, situated at the border between neurology and cardiology, is sometimes neglected by both specialties. History taking and clinical examination is in many occasions enough to decide about the most probable cause of a transient loss of consciousness (TLOC). When further examinations are needed, the most convenient is the tilt table test (TTT), which indications, physiological bases and pathophysiological principles in the most important syndromes presenting with TLOC are described in this selected breakthrough article (Saal et al., 2016).

The authors describe how the healthy subjects succeed to adapt their circulatory system to the shift of important blood volumes from the recumbent to the standing position, and how an episode of TLOC is announced by the recording of blood pressure and heart rate in patients with disorders such as reflex vasovagal syncope, orthostatic hypotension, postural tachycardia syndrome and psychogenic pseudosyncope. TTT has other positive effects: the patient can take preventive measures when he/she recognizes warning symptoms, thus lowering the rate of syncope recurrence. Also, the occurrence of a recognized event during TTT helps convince the patient of the certainty of the diagnosis, thus increasing his/her compliance and satisfaction.

Provided some precautions are taken (consider benefit vs. risk in patients with ischemic brain and heart disease), the method is safe. This manuscript should contribute to open the scope to the neurophysiological assessment of a neurological disorder commonly studied by cardiologists.