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Syncope or Seizure? Ask Observers

April 18, 2019

Written by Clay Smith

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Eyewitness accounts describing an event with loss of consciousness are helpful in differentiating seizure vs syncope or true seizure vs psychogenic nonepileptic seizure (PNES) but may not be as helpful in determining syncope vs PNES.

Why does this matter?
It can be a challenge to determine syncope vs seizure, especially if you’re trying to ask the person who was unconscious. Does it help to ask an eyewitness?

Differentiating DFO
This was a retrospective study of patients with confirmed diagnoses of either seizure, PNES, or syncope, about 80 in each group. They studied whether a Paroxysmal Event Observer (PEO) Questionnaire was more helpful than just the information they could glean from the patient alone. They found that observer-reported factors improved accuracy in distinguishing syncope from epilepsy, epilepsy from PNES, but not syncope from PNES. The methods of this study were very complex, and the PEO is a long list of questions. Ultimately, that is less important than the conclusion – you learn more about what happened to a patient with transient loss of consciousness if you ask both the patient and someone who witnessed the event what happened and how the patient looked during and after the event.

Value of witness observations in the differential diagnosis of transient loss of consciousness. Neurology. 2019 Feb 26;92(9):e895-e904. doi: 10.1212/WNL.0000000000007017. Epub 2019 Jan 25.

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Reviewed by Thomas Davis

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