Epilepsy Talk

Syncope or Seizure? | July 9, 2016

Studies have now confirmed what some doctors have long suspected — many young people who are given the diagnosis of epilepsy (or seizure disorder) apparently don’t have epilepsy at all.

Instead, they have a condition known as syncope.

Syncope (sing’-koe-pee), the medical term for fainting, is the sudden loss of consciousness and physical collapse due to lack of blood and oxygen to the brain. It can occur with or without warning — as an isolated event — or frequently, over time.

Since syncope can mimic the symptoms of some epileptic seizures — such as muscle twitching, shaking, convulsions and physical collapse — the confusion begins.

And that confusion can lead to misconceptions, misperceptions and a wrong diagnosis with ineffective medications given.

For example: What if you were given anti-seizure medication for syncope and developed irreversible heart disease? Or vice versa. You could be given cardiac drugs for epileptic seizures and there would be no relief.

Even worse, at least some of the arrhythmias (abnormal heart rhythms) that cause syncope, but are misdiagnosed as epilepsy, can become fatal if they are not recognized and treated appropriately.

What’s the difference? What’s syncope and what’s a seizure?

The difference is, an epileptic seizure produces a brief disturbance in the normal electrical functions of the brain, while syncope is caused by a reduction in blood flow carrying oxygen to the brain.

Other causes of syncope include some neurological disorders, psychological conditions, and obvious situations such as standing up too fast or being in a hot room.

These factors contribute to making the cause of syncope even more difficult to diagnose.

To make it even more confusing, a seizure can sometimes accompany a syncope episode and syncope can sometimes accompany a seizure!

Syncope is not caused by head trauma, since loss of consciousness after a head injury is considered a concussion.

However, syncope fainting can cause injury if the person falls and hurts themselves.

The person is unaware that they’ve passed out and fallen to the ground. Although they may hurt themselves in the process, it’s only afterward that they understand what has happened.

There may be symptoms or signs before the syncopal episode, (like auras) which may include:

Feeling muscle twitching, shaking, convulsions and physical collapse…a feeling of dizziness or vertigo (with the room spinning). Vision may fade or blur, and there may be muffled hearing and tingling sensations in the body.

During the episode, when the person is unconscious, there may a few twitches of the body which can again be confused with seizure activity.

Usually the loss of consciousness is not long. Once a person falls to the ground and the blood rushes to their brain, they rapidly regain consciousness.

After the episode, they come around rapidly and know where they are and not confused or disoriented.

Are you confused yet? Well to help understand the difference between the two, here’s a brief description of some likenesses and differences between syncope and seizures…

Seizures: Usually an aura involving sensory symptoms.
Syncope: Faint feeling, light-headed, blurred/darkened vision.

Seizure: Sudden, any position.
Syncope: Only occurs sitting or standing — avoidable by change in posture.

Seizures: eyes open, rigidity, falls backwards, convulses.
Syncope: Only occurs standing or sitting, eyes closed, limp, falls forward, minor twitching, (if unable to fall flat).

Seizures: Confusion, headache, sleepy, focal deficit.
Syncope: Pale, washed out, sweating, cold and clammy.

Other features
Seizures: Tongue bite, loss of bladder control common.
Syncope: Loss of bladder control rare.

And, as you may say, there are differences in the numbers, too.

According to the Epilepsy Foundation, approximately 10 percent of the U.S. population will experience seizure-like symptoms in their lifetime.

That’s about twenty-five million Americans (one in every ten) have had, or will have, a seizure at some point in their lives.

In the United States, the Epilepsy Foundation estimates that approximately $1.7 billion is spent in direct costs on patients with epilepsy and seizures.

With syncope, thirty percent of the U.S. population will faint during their lifetime, at a cost of more than $1 billion annually.

Yet anyway you look at it, there are important distinctions to be made. Diagnostic decisions, medications prescribed, and environment. All of which impacts upon the quality of lifestyle.

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  1. Another theory I’m questioning in respect to cause of seizures, is this intrusion of 43 unauthorized highly classified brain implants in the cerebral cortex. They were illegally imposed Dec. 9,1969 at 14 yrs of age, without informed consent, nor parental knowledge, while under the guise of treating epilepsy. (ie-“scar tissue removal”) Mind blowing, that these implants are not part of neurosurgical procedure or standard for 1969. Such as Robert DeNiro’s role in Frankenstein, I’m still questioning why I have 43 metallic implants in the cerebral cortex, and why all the secrecy. Recently, I learned through a article by John St Clair Akwei entitled Covert Operations of the National Security Agency,(NSA) on how Remote Neural Monitoring can induce hallucinations, seizures and other abnormalities. That what I see, they can see, and what I hear, they can hear. Most repugnant, that those who suffer epilepsy are subjected to unauthorized non-therapeutic brain surgical research, with the blessing of our Epilepsy AssoCIAtions, while our government imposes statutes as to deny unwitting victims access to the courts. With this lack of over-sight, accountability, and transparency, there should be legislation as to ban and prohibit brain surgery for epilepsy. Any survivor/victims of Dr. Harold J. Hoffman of the Toronto Hospital for Sick Children are welcome to contact me. http://www.thewhyfiles.net/mkultra4.htm#update http://www.ontariocourts.ca/decisions/2000/july/parker.htm


    Comment by hscguineapig414895 — July 9, 2016 @ 5:51 PM

  2. Yes Terry, I understand your point of view and the validity of it. And I do agree.

    But this matter is just distinguishing sycope and seizures which have nothing to do with surgeries just, as you might say, “mistaken identities”.


    Comment by Phylis Feiner Johnson — July 9, 2016 @ 6:54 PM

  3. i always question my seizures ..cause , many of the drs asked both parents , if any g-parents , aunts uncles , cousins , even had seizures ,. as i got older i asked my mom what if i had been “misdiagnose” back in the 60’s none of the older meds worked , when i had my first seizure, my lips were blue .. most of all my seizures , lips were blue .. but no auros ../ warnings .. but , always came , without warnings , could be talking to someone , then BAM, .. out cold .. .. have to ask my husband , sons on this , they have seen me have my seizures .. 10 yrs ago , was given , a Lupus test ” ANA .. test showed later positive , for lupus .. but one of the side effects , was seizures , & diabetes { but back then , only blacks , were diagnosed .. now its mostly Latinos, Asians , Native Americans , Blacks , now , Caucasians.. & only women , now men can also get it ..


    Comment by Cathy Flowers — July 10, 2016 @ 9:51 AM

  4. Cathy, it doesn’t necessarily matter if epilepsy doesn’t run in your family.

    If you have a close relative with epilepsy, the chance of you having epilepsy is only about 2-8%, depending on the specific type of epilepsy.

    And some people don’t have auras, while others are drug resistant. But that doesn’t seem to be the root of your problem, does it?

    What’s mysterious and interesting to me, is seizures as a side-effect of lupus. Do you still have both or either now?

    Do you take medication? If so what?


    Comment by Phylis Feiner Johnson — July 10, 2016 @ 11:21 AM

  5. no it doesn,t have to run in the family, I was the only one who has epilespy. I don,t know how old I was when I could tell you i was having a seizure, and could get rid of it. I could tell you if the feeling was weak or strong, when the seizure feeling in me from head to foot front and back.


    Comment by michele metzger — July 16, 2016 @ 11:38 AM

  6. The good news: just because you have a parent, sibling, cousin or aunt who has epilepsy, doesn’t necessarily mean you’ll have it also.

    In fact, if you have a close relative with epilepsy, the chance of you having epilepsy is only about 2-8%, depending on the specific type of epilepsy.

    The risk in the general population is about 1-2%.

    On the other hand, there is a 92-98% chance for the close relative of someone with epilepsy to NOT have the same condition!

    So, even though the risk in families with epilepsy is higher than in the general population, most people with epilepsy do not have any relatives with seizures, and the great majority of parents with epilepsy do not have children with epilepsy.


    Comment by Phylis Feiner Johnson — July 16, 2016 @ 12:20 PM

  7. Over the last 35 years I’ve had at least 7 EEG’s. All my EEG’s have been normal. Over the same period of time, I’ve also had three incidents physicians decided were seizures. I’m confused.


    Comment by Mike — August 12, 2016 @ 2:19 PM

  8. Mike, EEGs are not the be all and end of all of diagnostic testing. In fact, they’re just the tip of the iceberg.

    Take a look at this article:

    Beyond EEGs…Diagnostic Tools for Epilepsy


    You might need further, more comprehensive testing.

    Did they put you on any meds?


    Comment by Phylis Feiner Johnson — August 12, 2016 @ 2:23 PM

  9. That’s interesting, I didn’t really know about sycope although I had heard the word before. Thanks for the info. But I must say that an ‘aura’ is not just a warning, it is a seizure in itself, and also it happens to some people but not others before a different seizure happens, I wouldn’t say ‘usually’ at all actually.


    Comment by Lara — November 17, 2016 @ 10:18 AM

  10. That’s right Lara. An aura is a simple partial seizure, in and of itself.

    Thanks for pointing that out.


    Comment by Phylis Feiner Johnson — November 17, 2016 @ 11:47 AM

  11. no one on my dad,d or mom,s side of the family dosen,t have epilepsy. My brother and sister don,t have it either just me.


    Comment by Michele Metzger — February 20, 2017 @ 1:29 PM

  12. Same case with me.


    Comment by Phylis Feiner Johnson — February 20, 2017 @ 2:07 PM

  13. Syncope vs Seizure is quite interesting in my situation. I had two episodes of syncope in grade school. Both occured in the auditorium during religious events. The first was attributed to overheating in a warm place while wearing a winter coat. Yet, I was the only one to faint. The second one was three years later in Spring. I heard what sounded like trains in my head and woke up to people staring at me. No medical tests were done to see if there was a cause.

    Fast forward 50 years later, I started having partial sezures with a tightening of my throat, causing a woozy feeling in my head and then goose bumps from the top of my head running down to my finger tips. They came in clusters, 3-4 in days, then none for months. I never passed out and my GP had no clue what was causing them. He said the symptoms were too vague. Fast forward two years afterwards, I had a nocturnal tonic clonic sezure with a 15 minute post ichtal period. I have been seizure free (partial and tonic clonic) for two years on Keppra.

    The first question any doctor asks when trying to diagnose a seizure is whether you ever had a head trauma. Obviously, the two syncope episodes landed my head on the floor, one from a standing position, the other a kneeling position. Could these have caused seizures to begin 50 years later or were they actually the beginning of my sezures with a remission period of 50 years? At the age of 40, an iron fell on my head from a top shelf of a closet. Needless to say my iron is always at the bottom of my closet since then. At 50, I walked into the corner of our living room archway in the dark (nightlight was out). I am sure these head injuries could have helped to cause things stirring in my head.

    So, Syncope or Seizure? Who knows if those episodes in grade school were the beginning of my seizure history or actually the first head traumas that created my problems years later.

    Two weeks ago, I fell and broke my wrist. The first question doctors now ask is did your seizure disrder cause the fall? I doubt it, I was fully conscious when I fell, just seemed to trip, something I do frequently but don’t always fall. My neurologist attributes it to a balance problem due to my seizure meds and possibly some neuropathy in my left leg. It took me a year to restart my walking regimen after my major seizure because I was afraid of having a one and hitting the sidewalk with my head. Who knows how long it will take me to get over this new dilemma.

    My last comment is for those who question those normal EEG’s. How long are those tests? A 24 hour EEG tells a lot more about your brain’s activity than a one hour EEG. You may want to have a 24 hour EEG before questioning if you have been misdiagnosed. As Phylis says, EEG’s are not the end all in diagnosing seizures.


    Comment by Helen — August 19, 2017 @ 10:43 PM

    • I think we must be sisters under the skin. But, I would skip from the syncope to ataxia. I have the “falling disease”, have knocked my head on countless flagstone pathways and cement surfaces, with concussions to prove it.

      Cleverly, my Internist prescribed Physical Therapy and after 1 1/2 years, no falls. Up, down, or all around. Now I just work out with a Personal Trainer for core strength and balance.

      And I must admit, I’m enjoying my time upright, not staring at the ground.


      Comment by Phylis Feiner Johnson — August 19, 2017 @ 11:45 PM

  14. Hi Phylis,

    You are right, we must be sisters…I actually asked the orthopedic surgeon if I would benefit from balance therapy and he agreed but wanted clearance from my neurologist. She needs to see me before she will give the clearance. I think I will wait till my hand therapy is done before trying that.

    I am happy to hear that it helped you so much. That is what I want…to be able to stop bumping into things and tripping over nothing. 🙂


    Comment by Helen — August 20, 2017 @ 7:40 PM

  15. Interestingly, it is the same sense for a dog to be able to alert to either seizures or syncope. Once they alert, they can be partnered with an individual afflicted with either disorder.


    Comment by franboc — November 11, 2017 @ 9:07 PM

  16. Hi Phylis. After reading this, I realized that I have had episodes of syncope, especially under stress. Thankfully, I have not had seizures. One thing that has also frustrated me is that, because of the anxiety and depression issues that so often accompany people with epilepsy, I was also diagnosed with “pseudoseizures.” Could this be the case due to extreme case, is this syncope, or could it be a combination? Curious for your opinion. Thanks, Mary Ellen.


    Comment by megambon2164 — November 21, 2017 @ 9:18 AM

    • The difference is, an epileptic seizure produces a brief disturbance in the normal electrical functions of the brain, while syncope is caused by a reduction in blood flow carrying oxygen to the brain.

      But, with syncope, there are no psychological connotations as in “Pseudo Seizures”.

      Since syncope can mimic the symptoms of some epileptic seizures — such as muscle twitching, shaking, convulsions and physical collapse — the confusion begins.

      And it’s that confusion can lead to misconceptions, misperceptions and a wrong diagnosis with ineffective medications given.

      I would say that an EEG would distinguish between the two, preventing a wrong diagnosis and unneeded medication.


      Comment by Phylis Feiner Johnson — November 21, 2017 @ 10:36 AM

  17. Sudden loss of oxygen to the brain- definitely. When I was administered whooping cough vaccine as an infant, I had been taken to the hospital- a nurse just happened (by the Grace of God) to walk into the nursery, and here I was- reacting from the shot, and had stopped breathing. Probably one more second later, and I’d not be writing to you.

    Yes, this definitely was the stop in circulation- hence not enough oxygen in the brain. But, it is not syncope; have been fighting this for at least 64 years- and inability for Dr’s to have it under control. Refractory.


    Comment by Karen — December 31, 2017 @ 9:03 PM

  18. Madam what you are referring is right about syncope this tendency of sudden falling without seizures occurred even ayurvedic medical doctor does not said he told we only provide medication but cannot say even it is cured it depends on almighty god blessings keys to be kept in their hands at the moment lack of sleep overthinking to be avoided


    Comment by She'd yusuf — January 16, 2018 @ 10:15 AM

  19. I recently had an episode where I was getting blood taken at a lab as soon as we were done I was getting ready to stand up when suddenly I felt dizzy had tunnel vision and as the lab technician said I fell out of my chair went down to the ground convulsed eyes rolled back to my head and the episode may have lasted 40 seconds to a minute, after coming to it I was very confused as to where I was and did not know what was happening as I was told to sit down I began to sweat uncontrollably, what did I have?


    Comment by Quique — February 24, 2018 @ 7:34 PM

    • It was probably caused by of a sudden fluctuation in your blood pressure.

      A physiologic non-epileptic seizure can be triggered by some sort of change in your brain — typically a change in your supply of blood or oxygen, rather than electrical activity.

      Some possible causes of physiologic non-epileptic seizures include: Rapid drop in blood pressure. Low blood sugar levels.


      Comment by Phylis Feiner Johnson — February 25, 2018 @ 10:24 AM

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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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