Abstracts

Rationale: The differential diagnosis between epileptic seizures and syncopes is a common occurrence in clinical practice. Syncope is often preceded by a symptom complex characterized by lightheadedness, generalized muscle weakness, giddiness, visual blurring, tinnitus and gastrointestinal symptoms. These subjective symptoms are very important in guiding the diagnosis. After the faint the patients can also report some subjective feelings (e.g.residual weakness, nausea) The impression of coming out from a dream after the syncopal episode is a subjective symptom commonly reported by patients, if questioned. The aim of this study is to verify the occurrence of dreaming experience after syncope and after generalized tonic-clonic seizures (GTCS) and its diagnostic value in differential diagnosis. Methods: We prospectively investigated 100 patients with GTCS and diagnosis of idiopathic generalized epilepsy (Group 1) according to ILAE classification (Engel J. A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE task force on classification and terminology. Epilepsia 2001; 42: 796-803) and 100 patients with a certain diagnosis of syncope (Group 2) according to Guidelines on Management of Syncope of European Society of Cardiology (The Task Force on Syncope, European Society of Cardiology. Guidelines on Management (Diagnosis and Treatment) of Syncope - Update 2004 - Executive Summary. European Heart Journal 2004; 25: 2054-72): we questioned if they have never felt the impression of coming out of a dream after the loss of consciousness (GTCS or syncope, respectively) in order to verify the incidence of dreaming experience in the two groups. Results: No differences in demographic characteristics were detected between the two groups: in group 1 there were 38 males and 62 females, in group 2 there were 36 males and 64 females; mean age of patients with epilepsy was 38.6 13.9, of patients with syncope was 40.6 20.9. In group 1 nobody referred the dreaming experience, whereas in the syncope group 19 patients (19%, 4 males and 15 females) referred this subjective symptom. Conclusions: Dreaming experience seems to be an additional useful diagnostic clue for syncopal episodes, helping the clinician to differentiate them from seizures. In fact, when present, it can be considered specific for the diagnosis of syncope.