Transient loss of consciousness: the value of the history for distinguishing seizure from syncope

Hoefnagels, W. A. J.; Padberg, G. W.; Overweg, J.; Velde, E. A.; Roos, R. A. C.

doi:10.1007/bf00319709

Cited by 187Cardiovascular Syncope and Autonomic DisordersEpilepsy research and treatmentNeurological Complications and Syndromes

Transient loss of consciousness: the value of the history for distinguishing seizure from syncope

Hoefnagels, W. A. J., Padberg, G. W., Overweg, J., Velde, E. A., Roos, R. A. C.·1991·Journal of Neurology

DOI 10.1007/bf00319709

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Abstract

We studied 94 consecutive patients (age 15 or over) to investigate which aspects of the history and clinical findings help to distinguish seizures from syncope and related conditions. Clonic movements or automatism observed by an eyewitness classified an event as a seizure. The seizure group consisted of 41 patients and the syncope group of 53 patients. The likelihood ratio was used to calculate the predictive power of single findings and logistic regression to analyse combinations of findings. The best discriminatory finding was orientation immediately after the event according to the eyewitness and the age of the patient in the absence of an eyewitness report (P less than 0.001). We found a seizure five times more likely than syncope if the patient was disoriented after the event and three times more likely if the patient was less than 45 years of age. Nausea or sweating before the event were useful to exclude a seizure. Incontinence and trauma were not discriminative findings.

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Epilepsy and syncope may evoke one another on rare occasions, resulting in epileptic seizures triggering syncope as well as syncope triggering an epileptic seizure.
“Epilepsy and syncope may evoke one another on rare occasions, resulting in epileptic seizures triggering syncope as well as syncope triggering an epileptic seizure.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [410]
The results of interictal EEGs are normal in syncope.
“The results of interictal EEGs are normal in syncope.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [410]

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Authors: Hoefnagels, W. A. J., Padberg, G. W., Overweg, J., Velde, E. A., & Roos, R. A. C.
Affiliations: Leiden University Medical Center (NL)
Leiden University (NL)
ORCID: Padberg, G. W.
Venue: Journal of Neurology
Publisher: Springer Science and Business Media LLC
Published: 1991-02
Volume: 238
Issue: 1
Pages: 39-43
ISSN: 0012-1037 (ISSN-L)
0340-5354
1432-1459
DOI: 10.1007/bf00319709
OpenAlex: W1998965401
Cited by: 187
References: 29
Citations by year: 2026: 1 · 2025: 7 · 2024: 2 · 2023: 6 · 2022: 2 · 2021: 2 · 2020: 10 · 2019: 2 · 2018: 8 · 2017: 3 · 2016: 11 · 2015: 6 · 2014: 7 · 2013: 5 · 2012: 8
FWCI: 2.53
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Journal of Neurology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
Keywords: transient loss of consciousness, seizures, syncope, differential diagnosis, medical history, eyewitness reports, clonic movements, likelihood ratios
MeSH terms: Adolescent, Adult, Aged, Consciousness, Diagnosis, Differential, Epilepsy, Female, Humans, Male, Middle Aged, Prospective Studies, Syncope

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Transient loss of consciousness: the value of the history for distinguishing seizure from syncope

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