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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 pre-fainting symptoms and the circumstances of the precipitating event.

Not every one who collapses and jerks, or has a brief generalised seizure, has necessarily had an epileptic convulsion.
Jerking of limbs may also be seen with faints from a brief loss of oxygen to the brain.
 
   Likely to be a faint  Likely to be an epileptic seizure
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
Pre-fainting symptoms (light-headedness with dimming of vision)  Yes  No
Visual and auditory (hearing) hallucinations  Infrequent  Yes, as part of a complex partial seizure
Sudden onset Not usually Yes
Pale appearance Yes No
Bitten tongue Infrequent  – usually tip of tongue Common – usually lateral tongue
Urinary incontinence Infrequent Common
Brief stiffness and sometimes one-sided jerking Yes  Usually symmetrical jerks
Time period of convulsion <30 secs >1min
Confusion after the event No Yes
Rapid recovery Yes No
Drowsiness after the event No Yes
   
Note: Fainting without warning suggests a cardiac arrhythmia, rather a simple faint as outlined in column two above


 
Compiled by Stuart Mossman Neurologist FRACP MD