stress testing may be helpful in the diagnosis of channelopathies, such as LQTS and CPVT, which have adrenergically mediated arrhythmias The head-upright tilt table test (HUTT) may be used to provoke a hypotensive episode that mimics the patient’s symptoms However, it has low sensitivity, and current guidelines recommend it only in cases when the diagnosis of vasovagal syncope is truly unclear Pediatric patients with episodes of vasovagal syncope may exhibit convulsive movements during loss of consciousness that mimic epileptic seizures; HUTT may help in differentiating children with a primary seizure disorder A combined cardiology and neurology evaluation may be warranted in patients with syncope and seizure-like activity Additional indications for use of HUTT are recurrent syncope or exertional syncope in which heart disease has been ruled out, or recurrent syncopal episodes thought to be due to conversion disorder Neurologic Testing Neuroimaging is rarely required for a typical patient with syncope and the diagnostic yield is likely to be low The only indication for neuroimaging is for a patient with focal neurologic deficits or persistently altered mental status in whom it is necessary to rule out significant intracranial injury or cerebrovascular accident An electroencephalogram (EEG) may be performed on an outpatient basis if clinical features suggest a seizure and the patient has returned to a baseline neurologic status However, it is important to remember that a normal EEG does not rule out epilepsy TREATMENT Most children with syncope can be managed on an outpatient basis Patients with vasovagal syncope and their families will need reassurance and education about the benign nature of the condition They should be taught how to recognize prodromal symptoms and avoid precipitating factors such as dehydration, standing for prolonged periods, hot crowded environments, and diuretic intake Maneuvers to prevent venous pooling (such as keeping the knees slightly bent when standing for a long time, isometric contraction of extremity muscles, toe raises, folding of the arms, and crossing of the legs) or even assuming a seated or supine position may help Patients should be encouraged to increase their oral intake of water (up to L per day in an adolescent), to add salty snacks to their diet, and to avoid consuming caffeinated beverages If increased fluid and salt intake are not helpful, pharmacotherapy may be considered in patients with recurrent syncope