Most first events are diagnosed on history, and the patient's own account is often incomplete. A witness description — ideally by phone at the bedside — is the single most useful step.
Features favouring syncope include a clear trigger (standing, pain, micturition), a prodrome of light-headedness or greying vision, brief jerks lasting seconds, and rapid recovery. Features favouring seizure include a lateral tongue bite, head turning, prolonged rhythmic jerking, cyanosis and a prolonged confused recovery.
- Phone the witness before the patient leaves the department if no one came with them.
- A lateral tongue bite strongly favours a seizure.
- Brief jerks are common in syncope and do not establish a seizure.
- Prolonged post-event confusion favours seizure; rapid full recovery favours syncope.
Why it matters
A good history avoids both missed epilepsy and wrongly labelled epilepsy.
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