Fainting or an epileptic seizure?

At a glance

• Jerking can also occur during a faint.
• Confusion often persists after an epileptic seizure; orientation usually returns faster after a faint.
• Unexplained loss of consciousness also requires assessment for a cardiac cause.

Convulsions do not automatically mean epilepsy

Brief jerking movements can occur during fainting. Their presence alone does not establish epilepsy. Fainting may have a benign mechanism, such as a vasovagal episode, but can also relate to an abnormal heart rhythm or heart disease.

Features suggesting an epileptic seizure

• Head turning or unusual body posturing.
• More prolonged jerking.
• Tongue biting.
• No memory of what happened during the episode.
• Confusion after regaining consciousness, lasting several minutes or longer, with headache, fatigue or sleepiness.

After a typical faint, consciousness and orientation usually return more quickly.

When to consider the heart in particular

Concerning features include loss of consciousness:

• During exercise.
• Without warning symptoms.
• With palpitations or breathlessness.
• In someone with heart disease or an abnormal ECG.
• With a family history of sudden cardiac death at a young age.

Assessment starts with the history, physical examination and ECG. Further cardiac investigations, such as prolonged ECG monitoring, may be needed.

A neurologist or a cardiologist?

Sometimes both. The neurologist assesses whether the episode was epileptic; the cardiologist assesses whether it could have a cardiac cause. Investigations should not stop at “there were convulsions, so it must be epilepsy”.

Preparing for your appointment

• Write down what happened before, during and after the loss of consciousness.
• Bring a witness or their written account if possible.
• Bring ECG results and emergency department or hospital records, if available.