Summary
We studied 94 consecutive patients (age 15 or over) to investigate which aspects of the history and clinical findings help to distinguish seizures from synope 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<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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References
Ballardie FW, Murphy RP, Davis J (1983) Epilepsy: a presentation of the Romano-Ward syndrome. Br Med J 287:896–897
Binnie CD (1988) Electroencephalography. In: Laidlaw J Richens A, Oxley J (eds) A textbook of epilepsy, 3rd edn, Churchill Livingstone, Edinburgh, pp 236–306
Blumhardt L (1986) Fits, faints and funny turns. Practitioner 230:117–122
Commision on Classification and Terminology of the International League against Epilepsy (1981) Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 22:489–501
Critchley EMR, Wright JS (1983) Evaluation of syncope. Br Med J 286:500–501
Day SC, Cook EF, Funkenstein H, Goldman L (1982) Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med 73:15–23
Donselaar CA van, Geerts AT, Meulstee J, Habbema JDF, Staal A (1989) Reliability of the diagnosis of a first seizure. Neurology 39:267–271
Goodin DS, Aminoff MJ (1984) Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet I:837–839
Gulick TA, Spinks IP, King DW (1982) Pseudoseizures: ictal phenomena. Neurology 32:24–30
Harrell FE Jr (1983) The logist procedure. In: SUGI Supplemental Library User's Guide. SAS Institute, Cary, NC, pp 181–202
Kapoor WN, Karpf M, Maher Y, Miller RA, Levey GS (1982) Syncope of unknown origin. The need for a more costeffective approach to its diagnostic evaluation. JAMA 247:2687–2691
Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS (1983) A prospective evaluation and follow-up of patients with syncope. N Engl J Med 309:197–204
King DW, Gallagher BB, Murvin AJ, Smith DB, Marcus DJ, Hartlage LC, Ward LC (1982) Pseudoseizures: diagnostic evaluation. Neurology 32:18–32
Lai C-W, Ziegler DK (1981) Syncope problem solved by continuous ambulatory simultaneous EEG/ECG recording. Neurology 31:1152–1154
Lin JT-Y, Ziegler DK, Lai C-W, Bayer W (1982) Convulsive syncope in blood donors. Ann Neurol 11:525–528
Marsden CD, Reynolds EH (1988) Seizures in adults. In: Laidlaw J, Richens A, Oxley J (eds) A textbook of epilepsy, 3rd edn. Churchill Livingstone, Edinburgh, pp 144–182
Morris JA, Gardner MJ (1988) Calculating confidence intervals for relative risk (odds ratios) and standardised ratios and rates. Br Med J 296:1313–1316
Ormerod AD (1984) Clinical algorithms: syncope. Br Med J 288:1219–1222
Porter RJ (1984) Epilepsy. 100 elementary principles. Saunders, London
Ross RT (1988) Syncope. Saunders, London
Sackett DL, Haynes RB, Tugwell P (1985) Clinical epidemiology. A basic science for clinical medicine. Little, Brown & Co, Boston
Schott GD, Mcleod AA, Jewitt DE (1977) Cardiac arrhythmias that masquerade as epilepsy. Br Med J I:1454–1457
Sox HC, Blatt MA, Higgins MC, Marton KI (1988) Medical decision making. Butterworths, Boston
Theodore WH, Porter RJ, Penry JK (1983) Complex partial seizures: clinical characteristics and differential diagnosis. Neurology 33:1115–1121
Trimble MR (1988) Differential diagnosis of non-epileptic attacks. In: Laidlaw J, Richens A, Oxley J (eds) A textbook of epilepsy, 3rd edn. Churchill Livingstone, Edinburgh, pp 385–393
Warlow CP (1980) Blackouts. Practitioner 224:711–716
Wulff HR (1976) Rational diagnosis and treatment. Blackwell, Oxford
Zivin L, Ajmone Marsan C (1968) Incidence and prognostic significance of “epileptiform” activity in the EEG of non-epileptic subjects. Brain 91:751–778
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Hoefnagels, W.A.J., Padberg, G.W., Overweg, J. et al. Transient loss of consciousness: The value of the history for distinguishing seizure from syncope. J Neurol 238, 39–43 (1991). https://doi.org/10.1007/BF00319709
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DOI: https://doi.org/10.1007/BF00319709