![A woman falling to the ground because of syncope (fainting)](https://images.medicinenet.com/images/article/main_image/fainting.jpg?output-quality=75)
Syncope refers to fainting or passing out that occurs when there is not enough blood flow to the brain. Convulsive syncope specifically refers to syncope accompanied by tense or rigid muscles (tonic activity) or jerking movements and muscle twitching (myoclonic activity).
Convulsive syncope may be difficult to differentiate from a seizure, but it is not linked with epilepsy. Unconsciousness due to seizures is not considered syncope.
Syncope is temporary, with a loss of consciousness that comes on quickly and can lead to falling, and recovery is prompt and complete. Seizures, on the other hand, occur when there is a sudden surge of abnormal electrical activity in the brain that usually affects how a person appears or acts for a short time.
Causes of convulsive syncope are the same as syncope that does not cause convulsions, and can include:
- Reflex syncope (also called neurally mediated syncope, vasovagal syncope, vasodepressor syncope, the common faint)
- The heart slows or blood vessels dilate (widen) and blood pressure drops
- The most frequent cause of fainting results from a reflex response to some trigger, such as:
- Other types of reflex syncope include
- Situational syncope, or a sudden reflex response to a trigger other than those listed above, such as:
- Coughing, sneezing, laughing, swallowing
- Eating a meal
- Sudden abdominal pain
- Urinating
- Having a bowel movement
- Pressure on the chest after exertion or exercise
- Weight lifting
- Playing a brass instrument
- Situational syncope, or a sudden reflex response to a trigger other than those listed above, such as:
- Carotid sinus syncope
- Occurs in older people when pressure is applied to the carotid artery in the neck such as by a hard twist of the neck, wearing a tight collar, and pressing on the artery
- Orthostatic hypotension
- Low blood pressure on standing
- A drop in systolic blood pressure (the top number) of 20 mmHg or more on standing
- Serious cardiovascular conditions (cardiac syncope), which may be caused by”
- Irregular heartbeat (arrhythmia) and abnormal heart rhythm
- Aortic dissection, a tear in the aorta; very rare but life-threatening
- Aortic valve stenosis, or a narrowing of the valve between the heart and the aorta
- Postural Orthostatic Tachycardia Syndrome (POTS)
- Increased heart rate when standing: characterized by an increase in heart rate of at least 30 beats per minute on standing and orthostatic intolerance
What Are the Symptoms and Signs of Convulsive Syncope?
Symptoms of convulsive syncope may include:
- Lightheadedness
- Pale face
- Nausea
- Increased anxiety and restlessness
- Sweating
- Weakness
- Visual “gray out”
- Trouble hearing
- Collapse
- Tense or rigid muscles (tonic activity)
- Jerking movements and muscle twitching (myoclonic activity)
- Unconsciousness for a few seconds
- Full recovery after a few minutes
When Is Convulsive Syncope an Emergency?
See a doctor immediately if the above symptoms are accompanied by:
- Chest pains
- Shortness of breath
- Heart palpitations
- Heartbeat is faster or slower than expected
- Slurred speech
- Facial droop
- Weakness in any limbs
These may be signs of serious medical conditions such as heart problems or stroke.
It may be difficult to differentiate convulsive syncope from a seizure. Characteristics of a seizure that are different from convulsive syncope may include:
- Unconsciousness/seizure lasts for longer than one minute
- Loss of bladder or bowel control
- Tongue biting
- Convulsions
- Involuntary movements
- Drooling
- Lip smacking
- Staring into space
- Random eye movements
How Is Convulsive Syncope Diagnosed?
Convulsive syncope is diagnosed with a patient history and physical examination, and tests such as:
- Electrocardiogram (ECG or EKG)
- Exercise stress test
- Echocardiogram or transesophageal echocardiogram (ultrasound of the heart)
- Tilt table test
- Electrophysiology study (EP)
- In-home diagnostic monitors
- Holter monitor: a portable ECG worn continuously for one to seven days to record heart rhythms over time
- Event monitor: a portable ECG worn for one or two months that records only when triggered by an abnormal heart rhythm or manually activated
What Is the Treatment for Convulsive Syncope?
First aid treatment for a person who has fainted includes:
- Help the person lie down
- If the person is unconscious, roll them on their side and check if they are breathing and if they have a pulse
- Elevate the feet above the height of the head if possible
- If fainting occurred due to heat, remove or loosen clothes, and try to cool the person down by wiping them with a wet cloth or fanning them
- Check if the person was injured if they fell when they passed out
- In an emergency, call 911 if the person has not regained consciousness within a few seconds or recovered in a few minutes
The treatment for convulsive syncope depends on the underlying cause and may include:
- Catheter ablation
- Pacemaker
- Implantable cardioverter-defibrillator (ICD)
- Avoiding known triggers
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https://www.hopkinsmedicine.org/health/conditions-and-diseases/syncope-fainting
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fainting
https://www.epilepsy.org.au/about-epilepsy/managing-epilepsy/events-that-arent-seizures/
https://www.cedars-sinai.org/blog/fainting-or-seizure.html