Syncope toolkit
Differentiating vasovagal syncope epilepsy and psychogenic pseudosyncope
| Vasovagal syncope | Epileptic seizures | ‘Psychogenic’ Pseudosyncope (PPS) | |
|---|---|---|---|
| Trigger |
Common For example, pain, standing, medical procedure |
Rare For example, flashing lights |
Can be induced by anger, stress, panic, suggestion |
| Prodrome |
Presyncope For example, lightheaded, sweating, nausea, palpitations |
Aura, déjà vu, epigastric rising, unpleasant smell | None |
| Limb movements |
Irregular, asymmetrical Starts after TLoC |
Regular, bilateral or unilateral Onset coincides with TLoC or starts before TLoC |
PPS - none PNES – limb thrashing, pelvic thrusting |
| Tongue biting | Rare-tongue tip | Common-tongue side | Rare and minor |
| Duration of TLoC | 10-30 seconds | Can be minutes | Seconds to over 30 minutes |
| Post-TLoC confusion | Under 10 seconds | Minutes | Rare |
| Eyes | Often open |
Open May be rolled up or deviated laterally or jerking |
Closed |
| Incontinence | Can occur | Frequent | Rare |
| Fatigue after | Common | Very common | Rare |
| Cyanosis | Rare | Common | None |
| Frequency of episodes | May be days, weeks or years between | Variable | Frequent - may have several episodes per day |
Adapted from the 2018 ESC Guidelines for the diagnosis and management of syncope and IF IT'S NOT EPILEPSY PEM Smith 2001.
The inducing syncope video shows induced vasovagal syncope and demonstrates the convulsive movements on vasovagal syncope that may lead to a misdiagnosis of epilepsy.