SYNCOPE - CLINICAL-FEATURES AND DIFFERENTIATION FROM EPILEPSY

Confusion between syncope and epileptic seizures is a common problem i n clinical practice. Recently, new insights into the phenomenology of transient cerebral hypoxia have been gained from video analysis of exp erimentally induced syncope. Common elements of syn cope include multi focal and generalized myoclonus,tonic body extension, automatisms, voc alizations, eye deviations and hallucinations. Thus, it is not the pre sence or absence of these features but their specific character that d istinguishes syncope from epileptic seizures. Other clues for differen tial diagnosis include precipitating factors, premonitory symptoms and postictal events,such as tongue bites and postictal confusion,which h as been identified as the single most powerful factor discriminating s yncope from epileptic seizures. In contrast, incontinence and head inj ury are common in both conditions. Investigations such as electroencep halogram, tilt testing and postictal prolactin or creatine kinase leve ls may aid diagnosis but are never diagnostic in isolation. In rare ca ses, hypoxic and epileptic mechanisms may interact within one attack.