Syncope toolkit

Syncope is very common and will affect 42% of people during their lifetime

Differentiating vasovagal syncope epilepsy and psychogenic pseudosyncope

Vasovagal syncope Epileptic seizures ‘Psychogenic’ Pseudosyncope (PPS)


For example, pain, standing, medical procedure


For example, flashing lights

Can be induced by anger, stress, panic, suggestion


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


May be rolled up or deviated laterally or jerking

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.