Familial vasovagal syncope and pseudosyncope: observations in a case with both natural and adopted siblings

This report describes an 11-year-old girl with recurrent syncope beginning at the age of 2 1/2 years. Her paternal grandmother, father, and three of h er five natural siblings had similar symptoms, often linked to emotional up sets. There were three adopted children from a single family, and none of t hese had syncope. Prior to referral there was an increase in attacks, some with convulsions, but with no other features of epilepsy, Vasovagal syncope was confirmed. However, continuous electroencephalogram, blood pressure, a nd heart rate recordings during attacks indicated that in some episodes the re was neither cardiovascular change nor epileptiform activity, implying fe igned syncope (pseudosyncope) with pseudoseizures, A psychological origin w as sought, found, and in part rectified. The separation of vasovagal syncop e from pseudosyncope, in the context of the family history, is discussed.