Abstracts

Rationale: Sudden loss of consciousness especially with a history of jerking commonly leads to the diagnosis of epilepsy. Epilepsy is one cause of transient loss of consciousness and thereby needs to be excluded as a cause. However, seizures constitute only a small percentage of cases with syncope Methods: We present a consecutive series of 44 adult patients referred for evaluation of epilepsy in which the initial diagnosis was syncope, not epilepsy. Ages at time of referral was 24-72 years, with the duration of symptoms ranging from 0-65 years since onset. Of these, only 3 also had a diagnosis of syncope. Results: After extensive evaluation, only 2 patients had a definite diagnosis of epilepsy/seizures, 1 patient had a mixture of seizures and neurocardiogenic syncope (NCS), 3 patients had psychogenic non epileptic events, 1 patient had chronic fatigue and the diagnosis was inconclusive in another patient. Prodromal symptoms in these patients included dizziness (45%), diaphoresis (15%), and pallor (15%). It was also noteworthy that 38 (86%) of these patients were on antiepileptic medications (multiple agents: 2-7, in most cases) at the time of referral and the agents used included Felbamate in 2 patients, both of whom had the final diagnosis of neurocardiogenic syncope. Cardiac evaluation at time of referral had not included tilt test in any patient and when performed was abnormal in 75% of the patients. Conclusions: Prodromal symptoms including visual, sensory or motor symptoms were not predictive of a final diagnosis of seizures/epilepsy. Obtaining a good history is imperative to identifying patients with possible syncope. Neurocardiogenic syncope is the most common cause of reflex or neurally mediated syncope with an estimated lifetime prevalence of 30-40%. The prognosis of patients with this diagnosis is benign and treatment involves lifestyle modifications and/or medications but not antiepileptic drugs.