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Seizure versus syncope

Andrew McKeon1, Carl Vaughan, Norman Delanty

  • 1Department of Neurology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland.

The Lancet. Neurology
|January 24, 2006
PubMed

Insights

Diagnosing paroxysmal loss of consciousness is challenging, often requiring repeated assessments. A systematic approach using history, examination, and targeted investigations aids in identifying the cause, reducing costs and improving patient outcomes.

Area of Science:

  • Clinical Medicine
  • Neurology
  • Cardiology

Background:

  • Paroxysmal loss of consciousness is a common yet difficult diagnostic challenge.
  • Elusive diagnoses lead to significant mortality, morbidity, and healthcare costs.
  • Distinguishing between seizure and syncope is a frequent clinical dilemma.

Purpose of the Study:

  • To present a practical, systematic approach to managing patients with paroxysmal loss of consciousness.
  • To emphasize the importance of thorough history taking, examination, and differential diagnosis.
  • To guide the intelligent use of investigations and treatment selection.

Main Methods:

  • Adherence to basic principles of history and physical examination.
  • Formulation of a differential diagnosis for loss of consciousness.
  • Intelligent selection of specific investigations.
  • Appropriate treatment selection based on diagnosis.

Main Results:

  • A structured approach can improve diagnostic yield for loss of consciousness.
  • Discussion includes risks of sudden unexpected death in epilepsy and sudden cardiac death.
  • Many cases may still require repeated assessments for definitive diagnosis.

Conclusions:

  • A systematic, evidence-based approach is crucial for managing paroxysmal loss of consciousness.
  • Early and accurate diagnosis can mitigate mortality, morbidity, and financial burdens.
  • Continued vigilance and reassessment are sometimes necessary to reach a diagnosis.

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