EPISODES OFTEN MISTAKEN FOR SEIZURES: IS IT FAINTING OR A SEIZURE?
EPISODES OFTEN MISTAKEN FOR SEIZURES: IS IT FAINTING OR A SEIZURE?Many changes in motor function or behavior are commonly mistaken for seizures. These include fainting, tics, and other sudden jerking movements, breathholding spells, migraine headaches, and episodic changes in behavior. Doctors who are aware of these types of behaviors can take a careful history and can usually separate them from seizures.Is It Fainting or a Seizure?It had been a long church service and, as usual, Rebecca had almost been late. Her alarm had not gone off, and when her mother had called her there had barely been time to get dressed. No time for breakfast. Her mother told me, “The sermon was long and dull, and she remembers standing for the hymns and feeling dizzy. The next thing she remembers is waking up outside the church. She doesn’t remember passing out. The paramedic who happened to be there asked me if Rebecca had epilepsy. Does she? You’ll tell me the truth, Doctor, won’t you?”Fainting spells are commonly misdiagnosed as seizures. Indeed, some people have been treated for “epilepsy” for years when they had simply fainted. Fainting is caused by lack of blood going to the brain. Since one of the brain’s important activities is to maintain consciousness and posture, when there is not enough blood the person may become dizzy and slump to the floor. This decrease of bloodflow to the brain may be due to slowing of, or even brief pauses in, the heart rate. Or it may result from prolonged standing, with the blood becoming pooled in the legs or in the abdomen with not enough blood available to pump to the brain. Or it could result from anemia, with insufficient red blood cells to carry oxygen to the brain.In each case, the lack of blood initially causes a paleness, followed by sweating. The person feels “lightheaded,” or dizzy. The room seems to spin, and he or she slumps (not crashes) to the ground. As soon as the person is lying down, the heart does not have to pump blood up to the head, the blood supply to the brain is immediately increased, and within seconds he regains consciousness. He will usually still be pale and sweaty, may briefly be confused, and may still feel weak. Even though he has had a change in motor function and consciousness, he has not, however, had a seizure since that change was not caused by abnormal electrical activity in the brain.*20\208\8*
