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Epilepsy

Fit or faint


The most important factor in distinguishing between a faint and a fit is the history of typical presycopal symptoms and  the circumstances of the precipitating event.
Not every one who collapses and jerks or has a brief generalised convulsion has necessarily had an epileptic seizure. Such features may be seen in syncope.
 
  Faint Fit
Precipitating event hot environment, unwell, emotion, alcohol Yes No
Preceding sleep deprivation No –unless combined with other precipitants Yes
Age Usually young <25years Any age
Presyncopal symptoms Yes No
Visual and auditory hallucinations Infrequent Yes, as part of a complex partial seizure
Sudden onset Not usually Yes
Pallor Yes No
Bitten tongue Infrequent  – usually tip of tongue Common – usually lateral tongue
Urinary Incontinence Infrequent Common
Brief stiffness and sometimes focal myoclonic jerks Yes No except  primary generalised epilepsy – usually symmetrical jerks
Generalised convulsion <30 secs >1min
Typically of short duration
 
Yes No
Vomiting Infrequent Infrequent
Post ictal confusion No Yes
Rapid recovery Yes No
Post ictal drowsiness No Yes
  
Syncope and cardiac arthymia. Syncope without warning suggests a primary cardiac event. Prolonged QT assoc with deafness and early LOC preceding Ep seizure. This is a channelopathy with marked variation in phenotype Cardiac Rythmn changes and epilepsy.

Epileptic seizures can cause autonomic effects, including vomiting. In seizures tachycardia is common, bradycardia uncommon and asystole rare. Sympathetic overactivity can cause diaphoresis and pupillary dilation. Parasympathetic overactivity can cause pupillary constriction.
 
Compiled by Stuart Mossman Neurologist FRACP MD