Head up tilt testing has a place in distinguishing certain conditions from epilepsy

Editor—In their editorial J W A S Sander and M F O'Donoghue place great reliance on clinical characteristics to differentiate between epilepsy, convulsive syncope, and non-epileptic attacks.1 This seems unwise because the diagnostic success rate even of specialists may be as low as 50% on the basis of history and examination alone.2 Furthermore, direct observation of seizures by trained staff in a specialised inpatient unit resulted in only 80% diagnostic accuracy.2

One important omission in the editorial was the failure to mention head up tilt testing, which has assumed …