What seizure disorders present with syncope (loss of consciousness)?

From the Guidelines

Seizure disorders that present with syncope include epilepsy, particularly tonic-clonic seizures, and other forms such as absence epilepsy and partial complex epilepsy, although the latter two do not typically lead to falls or loss of consciousness. When evaluating patients with suspected seizure-related syncope, it is crucial to distinguish between epileptic and non-epileptic causes, as the management and treatment differ significantly 1.

Key Characteristics of Seizure-Related Syncope

• Tonic-clonic seizures can cause loss of consciousness and are often recognizable by their characteristic aura, post-ictal confusion, tongue biting, or muscle pains 1.
• Absence epilepsy and partial complex epilepsy typically do not result in loss of consciousness or falls, but rather an alteration of consciousness 1.
• Other neurological conditions like cataplexy, often associated with narcolepsy, can cause sudden loss of muscular control triggered by emotions, but patients usually have full recollection of events 1.

Diagnostic Approach

• A thorough history, including questions about aura, post-ictal symptoms, and witness descriptions of movements, is essential for distinguishing between seizure-related syncope and other causes 1.
• Diagnostic workup may include EEG, cardiac monitoring, and sometimes video EEG monitoring to determine the underlying cause of syncope.

Treatment Considerations

• Treatment of seizure-related syncope depends on the specific type of seizure disorder and may involve anticonvulsant medications 1.
• Non-epileptic syncope may require cardiac interventions or lifestyle modifications, highlighting the importance of accurate diagnosis to guide appropriate management.

From the Research

Seizure Disorders Presenting with Syncope

• Seizures can present with various symptoms, including syncope, which is a loss of consciousness caused by a lack of blood flow to the brain 2.
• Syncope can be a symptom of several seizure disorders, including generalized tonic-clonic seizures, which are characterized by a loss of consciousness and convulsions 3, 4.
• Other conditions, such as psychogenic nonepileptic seizures, stroke or transient ischemic attack, sleep disorders, movement disorders, and migraines, can also present with symptoms similar to syncope 2.
• The diagnosis of seizures in the emergency department is often clinical, and differentiation between seizures and other conditions can be difficult 2.
• Focal complex seizures, secondarily generalized tonic-clonic seizures, and primarily generalized tonic-clonic seizures can all present with syncope-like symptoms, although the duration and characteristics of the seizures can vary 5.
• Generalized tonic-clonic seizures are accompanied by changes in the autonomic nervous system, which can affect heart rate, electrodermal activity, and other physiological parameters 6.

Characteristics of Seizure Disorders with Syncope

• Generalized tonic-clonic seizures can last from a few seconds to several minutes, and can be preceded by an aura or other warning signs 3, 4.
• Focal complex seizures can last from a few seconds to several minutes, and can be characterized by a loss of consciousness and convulsions 5.
• Secondarily generalized tonic-clonic seizures can last from a few seconds to several minutes, and can be characterized by a loss of consciousness and convulsions 5.
• Primarily generalized tonic-clonic seizures can last from a few seconds to several minutes, and can be characterized by a loss of consciousness and convulsions 5.

Diagnosis and Treatment of Seizure Disorders with Syncope

• The diagnosis of seizure disorders with syncope-like symptoms requires a thorough clinical evaluation, including a medical history, physical examination, and laboratory tests 2.
• The treatment of seizure disorders with syncope-like symptoms depends on the underlying cause of the seizures, and can include antiepileptic medications, lifestyle modifications, and other interventions 3, 4.