Epilepsy Talk

Syncope or Seizure? | January 21, 2021

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 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 event and syncope can 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…

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

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

Features
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).

Recovery
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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Resources:

https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting

https://my.clevelandclinic.org/health/diseases/17536-syncope

http://www.medicinenet.com/fainting/article.htm

https://braindiseases.wordpress.com/2009/04/13/is-it-a-seizure-or-is-it-syncope-the-story-continues/

http://circ.ahajournals.org/content/113/16/e715.full

https://journals.lww.com/em-news/fulltext/2017/06000/infocus__clinically_differentiating_seizure_from.6.aspx

https://mmcneuro.wordpress.com/2013/06/19/blackout-was-a-fit-or-a-faint/

http://www.medsci.org/v06p0296.htm

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