As a cause of transient loss of consciousness, syncope is important in the differential diagnosis of epileptic seizures. This chapter examines the classification, diagnosis, and treatment of syncope in the clinical context of an epilepsy unit based in a neurological department of a university hospital. The frequency of syncope varies between 7% and 25% in different populations of healthy persons and patients. However, syncope may account for less than 3%, possibly 1-2%, of visits to the emergency department. With regard to prognosis, it is mandatory to establish whether an underlying cardiac cause is present and requires treatment. A good medical history may be decisive for a correct diagnosis, and routine laboratory tests, electrocardiography (ECG) including long-term ECG monitoring, blood pressure monitoring, carotid sinus massage, echocardiography, tilt-table testing, and video-EEG monitoring may be warranted, especially in patients with serious symptoms including falls with physical injury, or where occupational hazards are present. Treatment options are discussed briefly, as are two cases, reflecting upon the complexity of differentiating syncope and epileptic seizures.
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ABSTRACT: Non-epileptic seizures (NES) are episodes that appear as epileptic seizures, but are not caused by epileptic discharges in the brain. The inclusion of NES in the differential diagnosis of epileptic seizures is important, as an accurate diagnosis is required for the administration of appropriate treatment. NES in the differential diagnosis may be classified as (1) physiologic or pathophysiologic NES, e.g. syncope, sleep disturbances, motor symptoms, migraine attacks, etc., and (2) psychogenic NES (PNES), e.g. affective disorders with anxiety or panic, dissociative disorders (somatoform or conversion) as well as depression or posttraumatic stress disorder (PTSD). PNES is the condition most frequently misdiagnosed as epilepsy. We report NES as experienced in our epilepsy monitoring unit (EMU) for adults in the neurology department of a university hospital in Norway. Our main emphasis is on PNES, highlighting the diagnostic procedures, currently recommended treatment options, and follow-up. A team approach with video-EEG monitoring and clinical observation by trained nurses, epileptologists and other personnel is preferred in the diagnosis and treatment of PNES. Evaluations are performed by a neuropsychologist and trained social worker. The EMU closely cooperates with cardiologists and sleep center specialists. They can also refer patients to psychosomatic medicine specialists. Components of the differential diagnosis addressed are syncope, motor symptoms, sleep disorders, migraine and other paroxysmal neurological symptoms.
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