Is it a seizure or is it syncope? the story continues….

                      Is it a seizure or is it syncope? the story continues….

So our story ended with John in the ER. As many of you rightly guessed the first case scenario represents a typical syncopal episode while in the second case John had a generalized convulsion (seizure).

So what are the points in the history which favor syncope and which favor a seizure?

When a patient presents to a neurologist with an episode of loss of consciousness, it is imperative that we try to elucidate the underlying cause. As you can imagine the treatment of both these conditions is very different.

Syncope (fainting) can come either from the heart (we call this cardiogenic syncope) or from the brain (we call this neurogenic syncope or vasodepressor syncope or more commonly as vasovagal syncope). So for example you can faint (have a syncopal episode) if you have a sudden massive heart attack, or a transient arrhythmia of the heart (the heart beat fluctuates). As you can imagine these are potential lethal causes and hence patient’s who present with syncope are frequently evaluated for these cardiac conditions. Tests like ECG, prolonged 24 ECG (electrocardiogram) and sometimes an echocardiogram are ordered. Vasovagal syncope on the other hand is more benign and our patient John likely had a vasovagal syncopal episode in case scenario No 1. Another classical example of vasovagal syncope is when someone faints when he or she sees blood for the first time (frequently reported in medical students when they go into the OR for the first time).

 So what are the points which favor syncope?

1. Feeling light-headed prior to the episode

2. Feeling dizzy as if you are about to faint.

3. Blurring of vision at the onset of the episode ( Doctor I felt light headed, a little woosy, my vision started to go black and then I passed out)

4. Syncope usually occurs in an upright position (patient is usually standing when it occurs). Syncopal patients usually do not shake (that is they do not have convulsive movements. There is an entity called syncopal convulsion where in the episode starts with a syncope but then goes on to become a seizure. I shall not go into the details here as then it shall become confusing).

5. Usually the loss of consciousness is of very short duration. Once they fall to the ground and the blood rushes to their brain (as gravity has been eliminated), they rapidly regain consciousness.

6. They are not confused after the episode. They come around rapidly and know where they are (they are not confused and disoriented after the episode).

7. Syncopal patients usually do not bite their tongue or have loss of bladder control (wet their patients) during an episode.

What are the points which favor a seizure?

1. Patients who have a seizure do not get the type of prodomal symptoms which patients with syncope do. Meaning they do not feel light-headed, dizzy as if they are about to pass out. Seizures frequently occur out of the blue with no warning whatsoever. That said and done, some patients with seizures which come from the temporal lobe may get an aura. Multiple different types of auras have been reported in temporal lobe epilepsy (smell of burning rubber, metallic taste in the mouth, a rising sensation in the tummy among many others).

2. Seizures can occur in any position-standing, sitting, lying in bed and frequently in sleep too.

3. Patients who have a convulsion shake. We call this tonic clonic movements of the arms and legs (first they are noticed to stiffen up, the eyes may roll up or get deviated to one side and later jerking of the arms and legs occur).

4. The tongue may get caught inbetween the teeth as the patient is stiffening up or when they are having a convulsion (shaking). This frequently leads to a tongue bite (usually on the lateral border of the tongue).

5. When the patient stiffens up, the muscles of the urinary bladder go into a spasm and the patient may end having loss of bladder control (wet their pants). This may also occur when the seizure finally ends and the muscles relax.

6. Frequently patients after a seizure are confused and disoriented for a while. We call this the post ictal state.

7. Seizures frequently lead to loss of muscle tone. The patient falls and hits the ground hard. This may lead to cranio-facial injuries and even fractures. Patients with syncope on the other hand do not fall hard, rather thay seem to ease themselves to the ground.

As you can see now syncope and seizures may resemble each other superficially but a good history is usually able to clarify the diagnosis.

179 thoughts on “Is it a seizure or is it syncope? the story continues….

  1. Now your work begins when a cause must be determined for the seizures.

    Who comes up with these names, doctor? Tonic Clonic? Medicine has it’s poetry.
    I recall having two snycopes. One as a little boy in a hot church. I awoke seated on a wooden chair, head between my knees and some strange man smacking me on the back of my neck! Bewildering.

    What triggers a seizure, what ends it? Why does it stop, once begun? Just musing…
    Thanks for explaining the differences and what each can present.

    1. Hello there Paul,
      it is always a pleasure to hear from you and I trust you are well. I agree medicine and neurology in particular is quite beautiful The brain itself is a work of art, in all its complexity yet everything works just right. God’s supercomputer I call it, and Intel is no match in front of it.
      Neurology is full of fascinating and esoteric names. That is why many doctors in training are fearful of neurology and do not enter it as a speciality. Far more simpler to grasp the nuances of orthopedics or cardiology. But when I first dissected the human body, opened up the skull and held the brain in my hands, I fell in love with it . I should mention it was love at first sight !!!. Only a neurologist would say that and you can imagine that would not score very high if I am trying to impress a lady at a bar.
      Keep in touch and I wish you a good weekend. It is a lovely day in NYC with the sun shining and the skies ever so blue.
      Personal Regards,
      Nitin Sethi, MD

      1. my girlfriend often has black out episodes with her eyes open she feels light headed before the event she her body becomes limp and she does not respond often it happens when she is siting up and ussually when she gets too hot im starting to worry could you help with the diagnoses we have had a cat scan it came up clean she has also had an mri before and it revealed nothing we havebeen to a neurologist before and nothing came of it we are going to see another one soon this is really scaring me any advice or input you have would mean greatly to me thank you

      2. OK Since you are so intrigued with the brain and your knowledge sounds amazing.Maybe you can help me with my seizures epileptic non epileptic conversion disorder issues. OK I understand they say when they do an eeg my brain waves I guess dont spike? Now my seizures happen out of the blue fall flat on the floor have convulsions or clonic tonic loose consciousness, bite my tongue and or cheek and wet my pants.When I gain consciousness it could be minutes or hours. I cant speak confused When I can talk I stutter with no memory of what happened. I only remember the last activity or place I was before the seizure. I have cut my eye from falls cut my ear in half when I busted the side of a corner table off. I have scars bumps and bruises. Now is this is just in my mind that does not make any sense. I have read lots of articles about non epileptic seizures and that is not what happens to me. Also all my symtoms are epileptic. My other doctor say that there are several patients that have both types of seizures about 17% and some people have a normal eeg but still have epilepsy and vice versa. There have been cases that show epilepsy on the eeg but later on the person is fine and doesnt have it. Can you give me some advice and where I can get some help for this rare condition. I just know in my body its more than just my mental state of mind. Thanks Robin

    2. My 15 year old son had his first “seizure” at the age of 11 months. (his fraternal twin brother does NOT have the same problems) At the time, the doctors thought they were fever related. (not all of his seizures occurred with a fever however) He has continued having “seizures” off and on. Sometimes 1 in a years time, sometimes a few more. I have witnessed all of them, which tells me that he’s probably had some when I have not been present. He has had many tests geared towards epilepsy including sleep studies. They have all come back negative, meaning no signs of anything wrong with his brain from what they can tell. His episodes resemble seizures. The only two things from your list above that I have not noticed happening with him are the loss of bladder control and the tongue getting caught in his teeth. His eyes roll back, he sometimes stiffens, his body shakes evenly all over and he usually falls pretty hard unless I have caught him. He has often mentioned prior to the episode that his stomach feels funny. His most recent episode was so strong that it knocked me to my feet along with him. He has since caught up to my knowledge, but in early childhood, his muscle tone developed MUCH slower than his twin brother. He went through physical therapy and was told to swim as a way to gain strength. Swimming became his passion and sport of choice until he was recently told that swimming is the last thing he should be doing because of his seizures. In July of this year, Cameron was diagnosed with Syncope after having an episode during testing for it at the doctors office. (it was noon and because of missing the original appointment time, he hadn’t eaten or drank much prior to the testing which ironically set him up for the syncope episode) This sent him into a seizure BUT it was symptomatic of syncope. We have since learned that 4 of my husbands cousins suffer with syncope in different forms. My concern is that there are multiple things going on with my son. The doctors insist that he is not having a seizure, but I know what I see. What is your opinion on this? He is not on medication. He has only had one seizure this year. Well….two if you include the induced incident at the doctors office. He is SO EXCITED to be getting his learners permit and then his drivers license in 6 months. This worries me greatly. Thank you in advance for your input.

    3. If all of the symptoms of a fainting episode suggest syncope with the exception of rolling of the eyes before passing out and some minor body shaking, is rolling of the eyes consistent with the syncopal attack, or does it automatically suggest a seizure? Thanks, Bruce

  2. This is really good information! I am so glad you are still writing and sharing your knowledge and expertise with us. Thank you Doctor Sethi!

    1. Thank you Meander, hope you are well and all is good with family.

      Personal Regards,
      Nitin Sethi, MD

    1. Dear Elaine,
      loss of bladder control occurs more commonly with generalized tonic clonic seizures ( also called Grand Mal seizures). That said and done there are many seizures which may not be accompanied by loss of bladder control. Some syncopal episodes (syncopal convulsions) may be accompanied by loss of bladder control.
      So in summary there is no hard and fast rule.

      Personal Regards,
      Nitin Sethi, MD

      1. Dear Doctor Sethi,
        Many thanks for taking the time to reply to my earlier post. I found you in my search for information following my daughter being told she could have epilepsy. She has fainted twice on the London Underground system (not surprising some might say! 🙂 but on both occasions lost bladder control. My concern is that history and witness accounts seem to play a huge part in the diagnosis process and she has no witnesses that can now be contacted. The first time she fainted she was hospitalised and told after tests that Postural Hypotension was the likely cause. She saw her own doctor after the second episode and remembered to mention the bladder issue and immediately her doctor has reffered her to a neurologist, January appointment hopefully. My other concern is that her father was very very ill a few years ago with swelling in his brainstem around a cavernous malformation, very scary time and of course I worry about this type of abnormality being present. All I have is her account which is as follows – “generally, if i feel faint in the shower that morning then i know chances are, i’m gonna faint, which is about an hours warning, but… when its actually happening i know its coming because i’ll go from feeling fine to feeling sick and needing to put my head down and i’ll rest my head and the room will be spinning, then i know im about to go, i feel really heavy, like im sinking and then im gone” Does this account provide enough information for a neurologist to make an accurate diagnosis as to whether these are tonic clonic siezures or syncopal convulsions.

        I truly am glad that that you ‘fell in love with that handheld brain’ and I think eveyone else who has written to you would say the same!…..but as you say….best to contain the enthusiasm when at the bar :).

        Kind regards and thanks

      2. Dear Elaine,
        many thanks for writing in. Hmm well while there are few things in life which are 100% certain, your daughter’s history does make me feel syncope (vasovagal syncope) is the likely culprit. Though her GP is right about his concern for a seizure (due to the history of loss of bladder control), syncopal events too can be associated with urinary incontinence. This is more commonly seen when a patient has what we refer to as a syncopal convulsion. As the name suggests, the event starts off as a syncopal event but then due to prolonged hypoperfusion of the brain, a convulsion occurs. Her preceding prodrome (she feels the event coming), the light headness and fainting feeling after a hot shower too point in the direction of syncope.
        I though agree with a neurological consultation. A thorough history and physical examination and if warranted some tests like an electroencephalogram (EEG) and a neuroimaging study shall help clarify the diagnosis.

        Personal Regards,
        Nitin Sethi, MD

      3. Dear Dr Sethi

        Again…thank you. You have given me important information and an extremely valuable opinion which I feel would have been very difficult to get at this stage here in the UK. Many many thanks.


  3. Hello Dr. Sethi!

    Thank you for sharing your expertise. Question: I am having difficulty distinguishing if my boyfriend has a seizure or syncope yesterday. He was sitting on a floor fixing his computer. He got pinched by the back of the computer. Next thing I know he is saying “man, that hurt.” He is holding his hand; his had looking down and squeezing the pinched area. A second later, he was on his back, on the floor shaking. He blacked out. I think his eyes were open–I am not positive, but I remember that kind of. Within 10-15 seconds he comes back. He is coherent but very weak and dizzy. He has a very blank, non emotional look on his face. He starts vomiting within a couple of minutes. He vomited 4 times. He then goes to the bathroom for a bowl movement. He comes out feeling a bit better, but still pale. It takes about 2 hours for his color to come back and the look on his face to gain emotion; his eyes to become expressive.

    He has fainted one time before at a sight of blood and another time when he was walking on the steps; no one was with him on the steps, so he doesn’t really know a lot of details.

    I am very worried about him. Please advise. Thank you for your time.

    a concerned gf of 10 years

    1. Dear Lana (a concerned gf),
      thank you for writing in. From your description of the events which transpired, it seems more likely your boy friend had a vasovagal syncopal episode. As I have stated in my post, vasovagal syncopal episodes frequently follow an emotionally disturbing event (sight of blood, severe pain and so forth) especially if one is dehydrated or has been exerting.
      The fact that your boy friend “came back” within 10-15 seconds, was pale, weak, dizzy but coherent all point to a potential syncopal event. My advise shall be to bring this to the attention of his PCP. He/ she can determine if further evaluation is warranted.

      Personal Regards,
      Nitin Sethi, MD

    2. Please help us! My boyfriend was just diagnosed with NEAD. He out of the blue started having seizures at work Nov. 11th 2013. They thought it was epilepsy. The medication they put him on in Florida worked and he was only having a seizure once a week. Now while in the UK they decided to wean him off of the epilepsy medication because of their diagnoses here. Now he is having 10 different seizures in a 40-90 minute cluster three times a day, or night. It’s 20/40 or more seizures a day. I don’t sleep anymore. Does anyone know if there is a medication for his seizures? They are so frequent that we have no life what so ever. If he is not in bed he will pass out cold and fall flat on his face or head, and after his seizures he is wiped out and sleeps all day. His seizures take place while awake and asleep. He is safer in bed but this is no life at all. We can’t live like this. Please, if anyone can suggest something I would very much appreciate it. Here are his symptoms.Sometimes thay happen all at once or sometimes by themselves. I will also add syncope to the list after reading this.

      Thank you very much,
      L P and T B

      Syncope (Passing out while standing)
      Absence (petit mal) seizures. Staring at nothing.
      Tonic/clonic (grand mal) seizures. Violently shakes intire body.
      Rocking back and forth.
      Rolls up into a ball and bares down very hard.
      Only shakes head violently.
      Only shakes leg.
      Contorted fingers.
      Arches back.
      Smaking of lip.
      Memory loss.

  4. My daughter has episodes when she throws up. After she throws up, her eyes will roll back and she will either become real stiff, draws up in fetal position or begins to shake all over. Sometimes she just becomes real relaxed but with fixated eyes. Is this just a vaso thing happening or could this be something else.

    1. Dear Laresa,
      your daughter’s presentation has some features atypical for classical vasovagal syncope. My advise would be to bring these to the attention of her doctor.

      Personal Regards,
      Nitin Sethi, MD

      1. Dr Sethi
        A very easy to read and easy to understand explanation in your article .Thanks for the same!

        -My mother has had 3 episodes in the last year..
        Everytime she has gone to the toliet . Twice she fainted and fell from the pot itself, both times cutting her lip. The 3rd time ( a week ago) she was coming out of the bathroom and fell.
        – She has no recall of fainting or anything specific before that. At least two times she has complained of stomach pain/cramps when she went to the toliet. All 3 times this has happened in the night/early morning.
        – In the latest episode , we observed her. She was like in a shock, eyes wide open and not responidng. As she started coming around, she started speaking rapidly and a bit of incoherent/gibberish. After that she would respond logically , but mainly in English (otherwise normal conversation at home is in Hindi)
        – Our estimate is that her fainiting episode lasts 5-10 mins every time
        – Every time rushed her to ER- BP, Sugar, Electrolystes, ECG, CT were not alarming. Pulse was 56/57. Subsequent tests ( Echo, Halter, EEG) also inconclusive
        – Neuro opinions have differed- one suspects seizure other feels its cardia. Cardio opinion indicates Vasovagal and advises that avoid getting out of bed suddenly, any sudden expsoure to cold floor etc. Has prescribed Vertin 16 mg twice a day.

        We are fairly confused. Any advise from you would be appreciated.


  5. One more thing Dr Sethi which I forgot to mention, my daughter’s father has had fainting spells and has said the following……….”I was hot and I gulped my food. Something in the food burnt my mouth. The next thing I knew I was being helped up off the floor. My colleague said that I had collapsed face down in my food and had then collapsed on the floor twitching.

    Its never happened since then, but one thing that I remember and that is consistent with other fainting spells I have had is that when the food burnt me I experienced a shock, a rushing of blood type shock, a change in audio perception, a taste of copper (blood) in my mouth. These symptoms collectively or in part have always been present. Eg I only have to bang my knee cap or kneel on something (like a stone) and its like poking a raw nerve. I get a sensory shock where taste, sound, smell changes followed by nausea, sweating and faintness. I also get it if I bruise the palm of my hand at the base of the thumb.”

    More history for the January appointment but I would very much appreciate your opinion.

    Many thanks, yet again

  6. Dear Dr. Sethi,
    I am a 29 year old female that has a history of syncope x1. I recently was in the ER to have my ear irrigated as it was 90% clogged and causing me a great deal of pain. While the MD was irrigating my ear I blacked out with no warning. All I remember is waking up with the nurse and MD standing over me telling me that I had a seizure. CT, MRI, MRA, and ECG were all negative. EEG taken 24 hours later showed “cerebral abnormalities” which the MD interpreted as + seizure activity.

    MD now wants me to start taking anticonvulsants. I am suspicious about his diagnosis. First off, is it possible that cleaning my ear caused me so much pain or causes some kind of vertigo, balance issue, or nerve issue that caused me to pass out. Is it possible that when I passed out I then hit my head and the head trauma caused the seizure?

    I have no history of seizures and starting anticonvulsant medication will be life changing for me. I find it too cooincidental that my loss of consciousness occurred at the exact time they were cleaning my ear. The seizures were two apart and lasted for 30 seconds each per the RN. If the ear irrigation triggered the seizures are they likely to happen again? If I hit my head and it caused the seizures are they likely to happen again? Is it possible that these events were syncopal in nature and not true seizures? How long after a seizure is it possible to get an accurate EEG read? Mine was 24 hours after the event. I was confused for several hours after the events but I was also given IV ativan and started on a loading dose of keppra IV. It it possible that my confusion following the events was medication related and not truly post ictal?

    Your thoughts on this would be greatly appreciated.


  7. When I was in high school I traveled to the Dominican Republic to do community service work. I got a bad case of diarrhea and was sent to the local rural hospital. Because fluids were just passing through me, I was put on an IV. Within about 5 minutes I started to feel vasovagal signs – clammy, light headed, etc. However, I did not pass out. My body completely tensed up (felt like I had a charlie horse in every muscle in my body), went into fetal position, it was probably the most painful thing I’ve ever experienced. Lasted probably about 8 minutes before they pulled the IV out. But then my body was “stuck” in this tensed up position and it took a nurse massaging my hands for 10 minutes to bring them out of the fist position they were stuck in. I was completely coherent through the whole thing. My whole body was sore for days afterward, like I had run a marathon or something. There was no doctor there who could diagnose it and when I got back most doctors didn’t seem to really care about the story and I never got much beyond “probably just vasovagal”.

    Since then, I’ve had the more typical vasovagal symptoms around needles but never to the point of fainting or losing consciousness (other IVs related to wisdom teeth or knee surgery certainly caused me to feel like I would but by then I was unconscious from the anesthesia).

    I’m now 34 years old and about three weeks away from the birth of my first child. I’m going natural (no drugs) only to avoid the IV. But I’m still a bit freaked out about the possibility of IV if necessary – i just don’t want to go into that kind of muscle tension during labor – can’t imagine a baby coming out during that kind of response. Again, I’ve mentioned what I’ve been calling the “seizure-like” vasovagal reaction to my OB and he just nods like it’s all normal, and says we’ll just avoid IVs if we can. Not incredibly helpful. Any ideas? I’m wondering (hoping) if the dehydration might have been the cause of the more severe reaction when I was a teenager? Thanks in advance.

    1. I had a similar episode just yesterday ! I donated blood, then went up the stairs one floor trying to find my friends, couldn’t find them, went down, started feeling dizzy, sat down and fainted, went unconsciousness, they told me that I went into fetal position holding strong my arms and legs and woke up after a minute, I felt some pain but got over it in a few hours. The doctor made sure it wasn’t convulsion and then told me that I probably had loss of blood pressure and not to worry.

  8. My daughter has complained of passing out when whe throws up. Today I was there seconds later and saw her eyes roll in her head. She could not get up for a while. In a few minutes she got her strength, and I walked her to her bed. Then her stomach kept jerking in and out. She said she couldn’t control it, except breathing lightly made the jerking less severe. I talked to her for about 10 minutes, and checked her eyes before letting her go to sleep. From what I read here this sounds like a vasovagal syncope. How is this treated? It’s Sat. and I plan to get the Doctor on Mon. Thanks for your help

  9. Dear Karen,
    thank you for writing in to me. While I shall defer from diagnosing you over the Internet, some of the symptoms you describe do raise the possibility of a post concussive syndrome. Patients who have sustained a traumatic brain injury frequently fair poorly if on top of that they sustain a fresh concussion. The reason for this is that their brain is already compromised and handles the added insult poorly. The biting of the lip intrigues me. My advise to you would be to bring this to the attention of either your primary care physician or your current neurologist.

    Personal Regards,
    Nitin Sethi, MD

  10. About 3 years ago I had a cerebellar stroke, from which, thank God, I recovered about 98%. A couple of months after that, I had an episode after emerging from a hot bath, feeling dizzy and then passing out with eyes rolled back in head and fists clenched to my chest. It lasted, I’m told about 30 secs, after which I was weak but coherent. Yesterday I gave blood, no problems, but 10 min into the recovery period, I got nasuseous, dizzy, and climbed back onto a couch, but blacked out again, also with eyes rolled back and fists clenched to chest. This one lasted about 30 secs, too.
    Should I worry?

  11. Dear Doctor Sethi,

    I am writing for my wife, she is 36.

    Today moring she wake up at 6.14 am, but it was like sudden wake when sister called her. But she was ok that time, had a cup of tea, suddenly she felt dizziness and black out of eyes, sat down on the floor. After few seconds she was stood herself and went to bed take little rest. She laid down and after few minutes we see her not speakinng anything ( Eyes open but unconcious like state) and staring the eyes at us, I make her sit staight, but she was tending the head towards right. After reapeated wake up calls and massage on the face and speading water on her face, slowly she came to normal state of mind. The incident last for about 4-5 minutes. She passed urine also during this stage. Immedeately we took her to the nearest hopspital to emergency undergo ECG and 3 hours observation. 1st ECG, there was minor varation, after two hours they took another ECG, it was OK.

    They checked 2-3 blood tests. According to the cardiologist, they could not find any cuase. Then checked by the neorologist, also found no specific reason for it. Doctor, could you please give us any idea, how it occured and what precaustions we have to take.

    This incident happened for the first time in her life history.

    She is absolutely normal now.

    Thanks and regards


  12. Dear Doctor,
    My 6 year old daughter fainted this morning when was braiding her hair. It started when i asked her to move towards me and she didn’t answer so i asked again then i looked at her eyes and they were rolling back and she began falling backwards i caught her before she hit anything thank God! After the paramedics checked her vitals we took her to her pediatrician which basically said that she fainted and didn’t have a seisure…i have been reading your q & a stuff but i am confused– she was at first stiff then was jerking around & not breathing she was disoriented & pale. Her doctor only ordered an EKG no other tests is this typical? Should i be looking for another doctor.I didn’t get any answers i am scared to death for my baby.No loss of bladder either …the doctor also asked if i knew anyone with a glucometer to check her blood first thing in the morning…shouldn”t they have done that already? Is it too late to have a CT scan to see if she had a seizure? Your opinion asap would be greatly appreciated!

    one scared mama

    1. Dear one scared mama,
      thank you for writing in to me and I hope my reply finds your daughter in good health. As I stated in my post the answer (whether it was a seizure or did she simply faint) lies in the history (semiology of the event itself and of the events leading up to it) and not in a CT scan or even in a EEG. So if her doctor feels reasonably confident that it was a syncopal event (after taking a detailed history), then that may be enough (no further investigations may be warranted).
      If the history is atypical, her doctor may order additional tests such as a EEG and a imaging test (CT scan or MRI of the brain). So do not be scared but do follow up with your daughter’s doctor.

      Personal Regards,

      Nitin Sethi, MD

  13. Dear Danielle,
    thank you for writing in to me. A syncopal episode is usually short in duration. I explain it in this fashion to my patients: “once you suffer a syncopal episode/ faint and are now lying flat on the ground (meaning that gravity has been eliminated) the blood rushes up to your brain and you come around. You may be dazed for a very short time and wonder where you are and what happened but very soon you are back to your baseline and infact embrassed that you passed out.” So what I mean to say is that in a syncopal episode the loss of consciousness is for a very short duration. On the other hand after a generalized convulsion, a patient may be unconsciousness for some length of time and when they finally come to, they are frequently confused and disoriented and do not recall what happened. I wish you my very best. Feel free to write in if you have any further query.

    Personal Regards,
    Nitin Sethi, MD

  14. Hello Dr. Sethi-
    I came across your blog as I am trying to search what happened to my mom last night. She was feeling sick from 2 days, tired after long day at work no energy, high fever 102.6. She took medicines at home tylenol, theraflu and then had no fever by day 2 and felt fine all day except no energy and tiredness. She went to bathroom at night because she felt like throwing up. I followed her to the bathroom she tried to puke but could not. then she said I am feeling restless, her eyes rolled up and she fell. I was there so I holded her and shouted so she wakes up but good 10-20 sec she did not. Then I layed her comfortably on ground and went to call for my sister for help. I called 911 then. My sister slapped her and my mom gained consciousness. She woke up not realizing where she was; what happened to her. She thought we were waking her up from sleep. She was pale and sweaty. I ran to call my sister so do not know if she was jerking when i was not in room. i remember her eyes rollingbackward and i shouted calld her name several time and she did not wake up.

    The 911 came but we sent them back from outside because my mom insisted she is fine and I think was scared of charges as she does not have insurance. We went to a doctor in am yesterday and he wrote few blood tests, myself and my mom are more worried what happened to her, why she fell and if there is anything dangeous we should be aware and take treatment for. The doctor wrote test for Chlosterol. blood count, thyroid( as my mom has thryoid). Doctor took ECG and blug sugar test was 114 in morning- all was normal.
    please suggest what we should do. any other tests we should take to determine what caused it. Could it be low blood sugar or blood pressure she fainted? Do you consult such cases. I would like to make appointment with you after her blood results.

    Please ur suggestion is higly valuable. I am horrified from this episode and I feel so is my mom. Unless we know what occured; she is going to keep thinking and create more stress to herself and get sick again. Please help.

    1. Dear scared daughter,
      thank you for writing in to me. From your history, it seems to me that your mother suffered a syncopal episode (aka she fainted) likely on account of her running a fever and been dehydrated and weak as a result. That said what I would advise is to follow up with her primary care physician. Her doctor shall be the best person to determine whether this was indeed just a fainting episode (and no further work-up is needed) or whether other causes (cardiac causes of syncope) and or seizure needs to be ruled out.
      In the meantime, my advise would be to keep her well hydrated and ensure she eats a good meal and gets adequate sleep..

      Personal Regards,

      Nitin Sethi, MD

  15. Dear Dr. Sethi- Thank you so much for your response. I really appreciate your feedback. You are doing a very kind job. We got blood tests for my mom and they came ok except her potassium came little high. We went to see the doctor and he said it is normal when she had flu.

    All my best wishes are with you.


  16. Dear Latife,
    thank you for writing in to me. Since your “seizures” or rather I should say typical events continue inspite of you taking an anti-convulsant (Tegretol), I agree with you that the diagnosis of seizures should be re approached. A few things come to mind: either your diagnosis is wrong and that you do not suffer from seizures and that these events represent something else or your diagnosis is correct (you indeed do have seizures) but Tegretol is not the right anti-convulsant for the type of seizures you have or finally you have seizures, Tegretol is the right drug for the kind of seizures you have but the dose is incorrect or you are not compliant with the medication.
    As you can see there are many things to be considered. So my advise to you is to follow up with your doctor. He may like to order a video-EEG study. During the video-EEG, the goal is to capture one of your seizure/ typical event on the camera as well as EEG in order to characterize it.

    Personal Regards,

    Nitin Sethi, MD

  17. Hi Dr. Sethi,
    This is my first posting, and I have a doozie for you! My 8 yr old daughter has a complicated medical history. She has Chiari Malformation, decompressed x3, Adhesive Arachnoiditis of the Brain, been told she has deteriorating grey matter of the brain too, she has Ehlers Danlos Syndrome, Epilepsy, Aspergers, detethered spinal cord, suffers from insomnia and parathesia in her legs, has had menangitis three times in her short life, last time in September of last year and has had a couple bouts of vertigo the last couple of years. She is currently taking Focalin and Intuniv for ADHD, Neurontin (1800mg a day) for pain, and 200 mg 2x day for epilepsy. Seizures are partial complex and she had an eeg last fall that was clear. She has been on all these medications for over a year on most of them, newest (neurontin) was started last september. She is only on a 3 – 4yr old level.
    Two weeks ago while at school (she has a para proffesional that stays with her all day) her para, who knows her VERY well, called at 9:30 and asked if she had taken all her meds. Yes, she had, so we thought because she was acting “loopy” and “silly”, that maybe she was getting vertigo again. Para had said that she was kindof wobbly at the time. Within 45 min the nurse at school called and they said that she got really wobbly, was having a hard time walking and her speech was very slurred. Para (Bev) took her to the nurse and checked ears nose throat, temp, all ok. Took blood pressure and it was a little low for her. She gets her blood pressure taken daily due to high blood pressure. Bev said she was sitting in her lap then her head started wobbling and she closed her eyes and was out of it. She remained this way for a while. They took her blood pressure and pulse again and it was down more. They called me and an ambulance. Took it again and her bp and pulse was down more. Nurse said she had a pulse but it was faint. I know the second bp taken was 80/60, don’t know what the last bp or pulse was. She was “in and out” for about 25 min., even while lying down. In the ambulance her sugar level was taken, it was 80. Was taken to the hospital, given fluids, ate crackers and juice, slept for most of the afternoon. She was then transported by ambulance to the childrens hospital 2 hrs away, which is where most of her drs are. On the way, the paramedics said she had the same thing, bp and pulse plummeted and she was out most the way there. They did ct, xray, blood (white count was normal) flu was neg. ekg was normal, echo was normal, everything was normal. She was not dehydrated, no diarrhea. They don’t know what happened. She wore a 24hr halter, with no issues. I am certain it isn’t her heart. They said it may be her kidneys. She sees endocrinologist next week. She has had one more incident since, same thing happened. She can not tell me what she is feeling. She doesn’t understand dizzy or tingling. She is in daily pain, alot is releived with the neurontin. She still gets alot of stomach pains and leg pains. They are usually at night and worse if she has had a busy day. Oh, and since around last fall, she is constantly hungry. She will eat and then if she smells or sees something, even though she ate a full meal, she cries and says she is hungry and she usually eats all of what she gets. She doesn’t get alot of junk food. Loves meats, fruits and veggies. She has also gained about 8-10 lbs in 3 months, where she has always been extremely skinny and small. She is now 47″ and 58 lbs. Thank you for reading this extremely long post and any insight, or ideas about what is going on is greatly appreciated. She has stumped the doctors once again! She is a very happy, but complicated little girl ;o)

    mommy to Kenedy

  18. My son has had “seizure like” episodes since 2006. We have been to more doctors than I can even remember. He has been in and out of hospitals and NO ONE can seem to figure them out. Some docs say its really deep epilepsy so it does not show on EEG. Some Docs say they see epilepsy on the EEG. He had several MRI’s back in ’06 & ’07 and they all said “normal MRI”, he had another one in Sept ’10 that says he has a variance in the left/rt side of the internal part of the brain and several non specific foci in the white matter which they say can be scars. However, they were not there 4 yrs ago. Early on we were told these were Psychogenic – he went to Psychiatrist & Psychologist for 6 months, did a battery of tests and in the end, they say the medical docs need to keep looking because they find nothing psych that would cause this. We are so very frustrated. He is now wearing a 21 day event monitor to see if there is a cardiac cause. The echo & stress test were perfect, but he did have an episode 4 minutes into the tilt table. The Cardiologist says its not cardiac but the Neuro (2 different one’s) think it is. These events occur 5 – 10 + times per month and last anywhere from 2 minutes to 1 1/2 hours, he is unconscious, his eyes rolled back, he usually has big convulsions then a period of weird movements in the face. He is exhausted and confused afterward and does not know anything that happens from the time he goes out till a while after. The last video eeg (72 hr) showed epileptic markers before & after the event but nothing during. If you have ANY ideas we appreciate it. He is 18 and getting very frustrated and starting to get depressed because he cannot work or drive or be a “normal” teenager. PLEASE HELP us !!!!!!!!!

  19. My boyfriend has had two incidents, eight months apart. The first incident he came home and said that his neck hurt and asked me to rub his neck. Then he said pull up just a little on my head, that usually puts it back in place. I did that and he immediately went to floor, sounded like he was snoring very loudly and eyes wide open. I thought he was kidding with me, but when I saw his eyes I knew something was wrong. I didn’t know what to do, so I pulled him up to a seated position, kept talking to him, and he snapped out of it. He did not remember any of the event. He did say that he felt really hot up the back of his neck. This was during the daylight hours. He was very thirsty afterward and asked for water.

    The second incident we both fell asleep on the couch while watching a movie. I awoke to that same snoring noise, but his head was tilted to the side and his eyes wide open. It took me a little longer than the first time to snap him out of it. Once he stopped the snoring noise and “came to,” he immediately went and lay on the floor and said he was tired and just wanted to go to sleep.

    Has anyone ever had this happen to them? What should I do if/when this occurs again? Not sure sitting him up is the right thing to do.


  20. Hi Doctor

    Like most of the respondants I have mixed symptoms.
    When I black out I first get “funny thoughts”. I can’t remeber what the thoughts are afterwards but when I do get them I think “these are those funny thought again!”. I then sit down. I then wake up on the floor, unsure of how long i have been out of it. It usually take a me a little time to figure out where I am or what has just happened. I also lose bladder control. I sometimes get the thoughts but do not black out. After blacking out i am extremely tired and when possible I have a sleep ( not always possible as I have three young children). Every black out I have had no witness. I then usually feel light headed for the remainder of the day. My last blackout was a few days ago. My neck is sore and my head where i was laying so I assume I hit pretty hard even though I was sitting just before hand. When I had one last year I went for an EEG about a month after…all appearaed fine.
    What do you think it is?

    1. Dear Kylie,
      thank you for writing in to me. I shall not attempt to diagnose you over the Internet. That is just not good medicine. But I do have a few words of advice. Your events (as you state them) sound very suspicious for seizures. The routine EEG can be normal and that by itself does not rule out epilepsy/ seizure disorder. So my advice shall be to make an appointment to see your primary care physician or a neurologist at the earliest.

      Please feel free to write in again.

      Personal Regards,

      Nitin Sethi, MD

      1. Hi

        Just an update.As suggested I went to see a neurologist. I was unable to drive until all the results were in. I had an EEG, sleep deprived EEG (which was a living hell) and a MRI, blood test the works. All came back normal- it appears I am completely healthy! The mystery continues.
        Just a question- if I do have another “event” should I go to emergency so i can get diagnosed? It can take weeks before I can get an appointment at the specialist and by that time the symptoms are all clear.


      2. Thank you for writing in again Kylie. My advice as always is to remain in follow up with your doctor. You should ask him what he would advice if you were to suffer another event. Going to the ER if he is not available shall be prudent.

        Personal Regards,
        Nitin Sethi, MD

  21. My husbands family has a strong history of vasovagul syncope. My husband’s father, his brother, his sister, and my husband. Some of these people have the seizure-like convulsions after passing out. My daughter seems to be predisposed to having vasovagul syncope as well. She gets nervous in medical situations, etc. However, recently, she has had several episodes just while sitting at her desk at school. The first episode, she fell to the floor from a sitting postition and a doctor who witnessed it, said she convulsed for about 15 seconds. The second episode, she simply slumped to the floor, eyes open and staring, but no shaking. The third episode, she felt dizzy ahead of time, went completely stiff and rigid, then began convulsing for 15-20 seconds. She has had a normal sleep deprived EEG, and 2 normal EKGs. The only other noteable item, is that she has been experiencing significant abdmonial pain surrounding these episodes. She also has had 2 elevated SED rates, but no other abnormal labs. We are seeing multiple specialist, but they can not seem to tie everything together, and since there is a family history of vasovagul they are attributing these episodes to that. However, I am starting to feel like something is really wrong with my daughter. What tests, should I be asking for to rule out a more serious condition?

  22. Hi, Ive been married to my husband for 35 years. I remember when i was 19 my hub didnt come out of bathroom, i went in and found him passed out curled around the toilet, he was soaked with sweat. He was confused like “what happened? Over the years this would happen randomly. One time at friends house, he went to bathroom, didnt come out, so, i went to check on him, the bathroom door didnt have a knob on it so i looked through and could see he was passed out, i screamed and everyone came running, they had a hard time pushing the door open cuz his body was laying against it. He was soaking wet and this time he lost bladder control, we was wet all down front of his pants, he was totally confused after he came out of it. Oh, also, he had vomited before this happened. I begged to take him to the ER and no WAY he would go. On another occasion, he was simply sitting on a dining chair, he had got a splinter in his foot, he was fine and then all the sudden he fell out flat on his back, drenched with sweat and made snoring sounds. Again, no way he would let me call the ambulance. I’ve always noticed over the years he would get this dark, blank look in his eyes as if he where looking right through me. I always knew something wasnt right with that, it gave me the creeps actually. Also, as a teen, he wrecked “every car” he had, and he had like 4 over his teen years. I remember him telling me as a boy, he went to dentist and passed out. SO, yesterday, i took him to dentist for tooth extraction, When he was given the novacaine/epenephrine shots, he immediately started to clam up, told me he felt like he was going to vomit/pass out. So, i told dentist, they gave him water/cookies. The extraction was quick, after that, we went grocery shopping, i drove of course, and we had a 45 mile commute back home. When we get home, he went into the bathroom, i felt something wasn’t right with him, he had vomited, next thing i know, i see him come out, he fell to his knees passed out cold and was snoring like he was in a deep sleep. It happened so fast! I helped him up and he said “whats wrong? I said you fainted. He didnt believe me at first, BUT, my teen granddaughter witnessed all this. Anyway, he felt so sick, he went outside, sat on porch, took him shirt off, and held his head down, I went out there and he said just let me sit here a minute, I noticed he was soaking wet and clammy. I dont think he lost bladder control, if he did, it may have been very little. My question is could he have some form of epilepsy? And all these years never diagnosed? He got into a wreck 2 years ago, thank GOD, only his truck got totaled. And about 18 years ago, he wrecked a semi, he used to be a trucker driver for about 2 years. I have always felt there is something very wrong with him. I begged him to let me take him to the ER last night, but, he said just leave me alone, and thanked me. This is scary, he’s now 53. I wonder even if something may be wrong with his heart? Anyone, what do you think please?? Thank you so much!!

    1. Dear Jo,
      I share your concerns about your husband. His history certainly warrants a thorough neurological and cardiac work up to get to the bottom of the problem. Seizures remain high up in the differential diagnosis as do cardiac causes of syncope (fainting). I would certainly advice that he be evaluated on an urgent basis by a physician. Also since a question of seizures has been raised, he should NOT drive till he is cleared by a physician to do so. It is not safe for him and certainly not safe for other people who may share the road with him.

      Personal Regards,

      Nitin Sethi, MD

  23. Hi there,

    Before heading to my own doctor, I’ve been trying to do a little research (and hoping for a little reassurance) on the symptoms I have been experiencing for quite some time now. I’m 22 and have been “passing out” since I was about 5 years old. It’s mostly been at the sight of blood/pain or hearing a story involving blood/pain. Once it was just during a first aid video before they had even gotten to anything gross. The mere thought of pain – happening to anyone – just really, really freaks me out. I’ve passed out numerous times at school, the mall, anywhere. I have yet to pass out in the car, but have felt it coming on quite a few times while driving and felt that I needed to pull over just in case. I know that people having a phobia of seeing blood is quite normal, but it’s what I’ve been told about what happens when I pass out is the reason I felt the need to maybe check into it a little more. My eyes roll back, I convulse/have jerky movements, and sometimes lose control of my bladder. It feels like I’ve been asleep for hours whenever I regain consciousness, but still feel extremely tired after waking up. Also, I’ve developed some awful anxiety over the past few years, which I’ve heard could sometimes be associated with people that have heart problems. I recently went to my OB/GYN for a check-up and after checking my blood pressure (high), pulse (way high), and listening to my heart, she suggested that I ask my PCP to have an EKG done. I also experience palpitations that I wouldn’t say happen too too frequently, but maybe a few times a week. I have yet to see the doctor to check up on my heart, but with these possible cardiac issues I’ve thought that maybe my episodes really were just fainting. I know there’s not a real clear line between symptoms of syncope and seizure, but the involuntary movements and loss of bladder control are concerns of mine.
    Sorry for such a long message, and I’m not even sure if all of these things tie into each other, but just thought I’d go ahead and fill ya in with all the details! 🙂 I would love to hear some feedback if you have any. Thanks so much!

    – Callie

  24. I’m really happy I came across this site. We’ve been trying to sort out what’s wrong with my 14 year old daughter for the past 2 years. The school nurse was the one that noticed issues first. She would have “episodes” while at school nearly around the same time of the day..10AMish. They said she would go pale/cold sweat..she said that she would get a feeling wash over her liek something was off. Then tightness in her stomach and the rest was a blur. So the first thought was vaso vagal. Recently, she had a holter monitor on for month but all readings were good. What was confusing was that the schoo nurse would tell me she would spasm all over, then pass out, and wake up confused. It was until recently that we saw our first episode at home. We were coming home from grocery shopping, and she just stopped turned palish and stared off, I asked her if she was okay, and she said she felt something was coming and she just stared down at her hands. I immeidately had her lay down on the floor expecting her to pass out but what ended up happening was her whole body spasming. Her shoulders came off the ground, then her waist and stomach, her arms and hands were clenched..her eye were rolled back and doing fast movement. When she “came to” she looked confused and just stared at us. She didnt seem to remember all of it, she slept for a few minutes then looked normal, very fatigued. They’re hooking her up to a portable EEG machine tomorrow. I spoke to the school nurse and she confirmed that that’s basicaly what she does at school a few times a week. It’s so scary! Does that sound like vaso vagal or actual seizures?

  25. Hello… I posted here on April 1 regarding my son. Since then I decided to take him to a Genticist since NONE of the other types of doctors could figure out the problem. She sent us to a Cardiologist that specializes in Syncope & Arythmias. They did a complete workup for the Autosomal Nervous System. We are waiting for the results now. Our Neurologist had tried him on a high dose of Inderal because although the Cardiologist cleared him and said there was NOTHING wrong with his heart, the Neuro still thinks there is. Now both the geneticist and the new Cardiologist agree with our Neuro that there is a problem with the electrical system of his heart. The Inderal seems to be helping and he is on week 7 of NO seizures. PLEASE… if you are reading this… do not give up and let the doctors tell you your problem is of a psychiatric nature. Our new doctor said that all of the seizure meds that he has been on could have killed him and doing nothing but talking to a pysch doc could have killed him as well. The liklihood that grand mal seizures are of a psychiatric nature is small despite the fact that most Neurologists and Epilepsy docs will tell you that if they don’t see anything on the EEG. We have dealt with heart ache and stress beyond imagination over this 6 years and all along if the docs had not been so quick to dismiss as a psych issue, maybe we would have had a proper diagnosis much earlier. I am not saying all docs are bad, I just think they need to open their eyes a little more and listen to the patients and their families.

  26. Hi,

    I was wondering whether you could help me, I have had numerous incidents in the past which I would describe as ‘fainting’ I have been referred by my doctor and had multiple tests done, MRI, EEG, ECG, and many more.. The consultant then concluded that It is Vasovagal Syncope. I am a full time athlete and it is becoming more and more of an issue, the only reason I have recently began to question what happens is because after someone observed a recent episode they began to make comparisons about themself (as an epileptic sufferer) they also suggested that tests could come back normal and this doesn’t neccessarily mean you do not have epilepsy and that symptoms are important in the diagnosis. The symptoms I have recorded to experience on the days in which it happens, is general tiredness. And afterwards my eyes are often very sore and heavy. People often say that my eyes twitch and most of the time I remain conscious.

    Any advice would be greatly appreciated.
    I guess I would like to know whether in your’e opinion it is worth going to see the consultant again as I actually have video footage of a recent episode but only from a distance.

    1. Dear Christie,
      thank you for writing in to me. In order to maintain your confidentiality I have hidden your email address. My advice to you would be yes it shall certainly not hurt to get another opinion though you say you have had multiple tests (including EEGs and EKGs) and the conclusion was that you suffer from neurocardiogenic syncope (vasovagal syncope). Since the episodes continue it may be prudent going back to your doctor for a follow up visit. Make sure you take the results of all the tests you have had in the past. Also the video shall certainly be helpful. A trained eye (neurologist) may simply by looking at the video be able to determine whether the event is a a seizure or a syncopal episode.

      Personal Regards,

      Nitin Sethi, MD

  27. Hello, we are confused about whether or not my husband had a seizure or syncope and would REALLY appreciate any help you can provide. He had what appeared to be a seizure while standing in shallow water (complicating the ability to describe his body movements) then collapsed into water. Face was submerged for less than 10 seconds, and upon removal from water, skin was pallid and lips were blue. Eyes were wide with small fixed pupils and shallow, mechanical/reflexive type breaths evident and small jerking movements, strong pulse. He ceased movements and was removed from water within 2 minutes and retained consciousness after being removed from water with effort from an attending nurse who had come to assist. Tachycardic, with pulse slowing in recovery but strengthening when spoken to. Irritable and somewhat confused for first few minutes. Blood glucose normal in ambulance and ECG/blood screen normal at emergency room. The dilemma is this: he had not eaten all day or had anything to drink and had been labouring in heat and sun, but was not under exertion at time of event (had stopped working 1 hour prior). Emergency physician diagnosed seizure event, as did two neurologists who were consulted by telephone. MRI performed three days post event was within normal limits with no evidence of edema, skull abnormalities, infarct, bleeding or tumours (Gd contrast used). Neurologist examined him yesterday, six days post event and diagnosed syncope, NOT seizure and ordered cardiac ultrasound and holter test. Does this sound like syncope to you? Or seizure? And if it was a one-time seizure or syncope with no structural indications, what other follow up should he have, differential diagnoses excluded, or precautions should he take, if any? EEG results are pending but initial verbal report was normal (I believe). Any insight would be greatly appreciated.

  28. My son is 15 and suddenly had a seizure at 12 for no apparent reason. The first seizure he had was when he was lying on the sofa watching TV and he fell onto the floor. I thought he was playing a trick but found it wasnt. After that one was set off by playing video games. He had played for about 20 minutes and fell forward. After that 2 others were from running in the hot Ky summers. The weird thing is that there was some type of thing that happened for a whole month that his eyes would roll back but I could keep him contious and it would pass. His 2 brothers worked with him for 30 minutes of lightly smacking his cheeks and making him answer questions and then it passed.In Ky the doctor would test him each time monthly that he came to the office and they would make him breathe rapidly and see how long it would take to go into a stare. At first it would take 30 seconds and then they were happy that it took 2 minutes. he now only has a seizure within 30 minutes of being in bed and this would be after not sleeping enough or eating right or if family started fights. He has been to huntington and to buffalo ny. They cannot tell me if this is permanent or what caused it. What are your thoughts. He has had 5 grand mals this year.

  29. I was diagnosed 4 years ago with epilepsy at the age of 40. I never had anything like this before. The first time I was watching a thunder storm. I was sitting on a bus. The second time about a year and a half later, when I was diagnosed, happened as I was speaking with a customer while standing. This is when I was told that I had epilepsy. At this time, I had been sick for a few days due to what I believe was food poisoning. I have had issues with my blood pressure for years. One time I am ok and the next three it is high or low. My pressure doesn’t seem to be constant. I have not taken medication for over three years. In April 2011, I had another issue but am not sure what happened. I did not go to the doctor. I did not eat all day and I had been looking for lichens, which are a mutation of fungus and alga, for a science class. I do not know if this episode occured due to not eating or trying to find the correct organism. The reason that I am asking this question is I do not like the neurological clinic that diagnosed me (I need to do this for my drivers license and they can’t see me until February 2012 and it is currently August 2011). I have scheduled an appointment at another clinic. Are there any questions or tests that I should request from this new clinic. I have known two people who where wrongly diagnosed with epilepsy. The first clinic already cost me my occupation that is why I am taking college classes at 44. Thank you.

  30. Hi,my husband had something like this happen 6 years ago and then again today,He said everything went black and everything got loud. He didn’t know he had one today until he seen he wet his pants like last time. He just blacked out, he didn’t shake. The Doctors today said Syncope/seizures,he drives a truck and the doc. said he cannot drive for 6 weeks. Could you help me pinpoint which one it is? Thanks

  31. Follow up to my April and August posts….. We finally have a firm diagnosis. My son has Postural Orthostatic Tachycardia Syndrome. He has kind of a weird manifestation of it,
    as usually patients do not have the seizures with it, but my son does. You can read a description in my April post. He has been on the Inderal since June and except for the first 2 weeks on the meds, he has been seizure free. To anyone without a diagnosis, it would be worth getting an appointment with a doctor that has the equipment and testing for Autosomal Nervous System issues. It took us almost 6 years and lots of heartaches to get where we are. Don’t give up please………………

  32. hi, My son 24 had this happen to him he was sitting with brothers friends 2 days age. He fell sick saw things in his eyes, got up walked out fell hard to floor started shacking all body, his eyes were rolling got stiff, woke up they sat him up then went in it again when he got out of this he did not remember any thing was confused, whit or pale looking. i took him in ER, a PA said it was synocope, how can we find out a real diagnosis what he had that day, to make sure it was not seizure . oh they said his white blood cells where high but that it was normal. thank a concern Mother Diane

  33. Dear Laura,
    thank you for writing in to me. In my personal experience, patients usually do not report muscle jerks or confusion prior to having a vasovagal syncopal episode. Usually what they report is a prodromal event–they feel the episode coming and become light headed or dizzy, pale, vision may get blurry and then they slowly ease to the ground and may suffer a momentary loss of consciousness. Once they hit the ground, the recovery is pretty quick and a prolonged period of confusion is seldom reported.

    Nitin Sethi, MD

  34. I am a 35 yr old female, 110 pounds, healthy. My problem is I went to see Breaking Dawn and that movie has reported seizures hence my dilemma. Friday night during the movie I felt good. I went to take a bite of popcorn and was overcome with a sense of nausea. I said I wanted to leave as I suddenly felt the need to vomit. I stood up and seen nothing but white. I could hear my friend asking if I was ok but I had no control over my legs or arms. My heart was beating fastly and I asked to be taken home. I was told I became extremely pale and lost consciousness 3 times on the walk to the exit to the theatre. I could hear the movie attendent ask my friend if I needed help. All I remember after that was seeing all white and being in an all white 3D dream. I woke and thought I was in bed at home and asked to be left to sleep. I was merely irriated I was being bothered. I was told I was outside the movie theatre. I was highly confused and didn’t recognize my surroundings which sent off fear through me. My head felt numb and tingly and that scared me as well. I asked why I was all wet but noone answered me. I was told later, after home and a little more alert, that I went down hard, that my eyes rolled back in my head and I lost body function and urinated myself. I was out for 15 seconds more or less. I was told I was being tapped in the face and my name being called. I remember nothing byt white and a dream. I have had tingling and numbness in my head since and have been extremely tired. I have twitches between my eyes and some inside my head that are alarming me. Now, because of the damn movie repors, I am not being listened to. I am suddenly a vixtim of this Twilight movie. I do not buy this. Prior to Friday, on Wednesday I lost track of time at the hair salon. I looked up from a magazine I was reading and felt like I had completely zoned into the magazine for hours. I felt disorientated after and like I would faint but I said nothing and breathed through it. I chalked that up to anxiety over being alone on the holidays. The whole week leading up to Friday I would forget my dogs name calling him my old dogs name and completely drawing a blank to his name. I also got confused coming home and didn’t recognize the streets. But, I gather this is all the result of the Twilight movie too. Any suggestions as to what may be the real culprit because I simply just don’t know.

  35. Hi, im trying to figure out what s wrong with me. It ‘s been happening when I try to go sleep…I lay in bed and it feels like a sort of dizziness and I proceed to leg myself fall asleep and it feels like my eyes roll back in my head. I catch myself, then get scared. I did have fainting issues when I was younger, but not recently. However, I have been drinking alot of caffeine lately. I just this moment let myself try to fall asleep through this weird sort of dizziness/eyes rolling back episode and I like snapped out of some weird faint/sleep thing. I don’t think this is normal…please help…im worried.

  36. I experienced something a few days ago. Without any warning as I was getting out of my chair, I hit the floor hard. I woke up after a few seconds and I was in a cold sweat, shaking and confused. I tried to get up, but, I couldn’t move for another few seconds. I am under a Neurologist’s care and he suspects complex partial seizures due to an abnormality on an EEG, but, he is not too sure. I went to the ER and everything seemed normal. I had another episode a few days later, the same thing, except this time I was just walking from one room to another and it happened. I have no idea what this could be. I have been accused of “spacing out” and I have callouses on my left finger knuckles. I never realized I was rubbing my fingers enough to get callouses. Is this seizure or just passing out? So confused!!

    1. Dear Char,
      thank you for writing in. The episodes do sound suspicious for seizures though as my post indicates there is a broad differential of sudden unexplained loss of consciousness. Broadly speaking there can be three types of seizures:

      1. Generalized seizures: as the name suggests in primary generalized seizures, the seizure starts off from the entire brain at the same time. So for example if you were to suffer a generalized seizure while the EEG is running, the EEG will show abrupt onset of epileptiform activity from the entire brain (both the hemispheres). Primary generalized tonic clonic seizures (at times referred to as grand mal seizures) are quite dramatic. If the person is standing when the seizure strikes, he shall suffer loss of body tone and fall down. Patients usually strike the ground hard and may suffer craniofacial injury as a result. There is complete loss of consciousness (so the patient shall be amnestic for the seizure). There is an initial tonic phase where in the body stiffens. This is soon followed by a clonic phase where in rhythmic inphase jerks of the limbs are observed. The patient may suffer a tongue bite or may suffer loss of bladder control during the ictus. The seizure itself lasts for about a minute or two and is followed by a more prolonged post ictal phase during which the patient has stopped shaking but is somnolent and difficult to arouse. The past ictal phase may last for about an hour with slow recovery of complete consciousness and a return to baseline. Of note the staring spells seen in children (also called Absence Epilepsy) is a type of generalized epilepsy.

      2. Focal seizures/ partial seizures: as the name suggests these are seizures which arise from a focal area in the brain. Focal seizures are not accompanied by a complete loss of consciousness. Rather there is impairment in the level of consciousness/ awareness. Let me explain further. Let us assume that you are right handed. In people who are right handed, the left hemisphere is the dominant hemisphere and in the left temporal lobe is the speech center. Let us assume you suffer a focal seizure arising from the left temporal lobe. There shall be a sudden arrest in your behavior and you may stop speaking (since the left temporal lobe is now misfiring). If I speak to you at this time, you shall not reply back to me and you may not recall that I had spoken to you later. That said unlike a generalized seizure, you do not fall down and do not convulsive. This is what we doctors refer to as a complex partial seizure (complex because awareness is impaired).

      3. Focal seizure with secondary generalization: I think this is simple to understand now. The seizure starts off as a focal seizure but then spreads and crosses over to the other side of the brain and very soon (in a matter of milliseconds) the entire brain is showing the epileptiform activity. So initially you have a behavioral arrest and cannot speak but then very soon your entire body tenses up and you start convulsing.

      I hope I have been able to explain the seizures to you in very simple terms. Follow up with your doctor. My very best to you.

      Personal Regards,

      Nitin Sethi, MD

  37. Dear Sandra,
    I am glad you found my blog helpful. More than likely she suffered a vasovagal syncope (caused by the blood draw). Many patients who suffer a syncopal episode have a brief period of stiffening or exhibit other seizure like activity. Some may even proceed to have a full blown convulsion. This is referred to as a syncopal convulsion or convulsive syncope (meaning that the convulsion was triggered by syncope). These patients usually do not warrant to be on anticonvulsant therapy.

    My advice to you. Bring this episode to the attention of her doctor and let him/her evaluate her. Also to prevent such future episodes, make sure she is lying down and well hydrated when she has her next blood draw.

    Personal Regards,

    Nitin Sethi, MD

  38. Good day, I am a 27 yr male who has been dianosed with mild syncope. To my knowledge there is nothing I can do to change this from occuring. I guess you could say they have became worse over the years. First few times were very disturbing. I have gotten use to the fact that they happen now from time to time without warning for the most part. I usually can feel it coming but I can’t control really what happens at that point. Symptoms as far as I can tell are that my body becomes very hot all of a sudden. Stomach becomes upset, My body tends to I guess you could say convulse a bit basically no control over that. I am some what coheirent but I don’t seem to be all there so to speak. On top of that most times I wake up and suddenly fall right back out again. Never lasts too long as far as being blacked out, but afterwords I’m still a bit groggy for almost 20 or 30 mins after. Like I’m just going thru the motions, or waking up from oversleeping. Takes a minute for me to get my bearings. Each time it happens I have completely blacked out. Many have told me my eyes roll in the back of my head. Others say I was shaking, others say I was twitching. Also been told My eyes were wide open, just zombie mode, and that I have hit my head pretty hard, most recent incident I must have fell pretty hard because I did a number on my knee. I have also had bladder issues and bowl issues, not everytime but some of the time just complete lack of control. I have had complete work ups done, heart monitors, tilt table test, MRI, CAT scan. The only diagnoses I get is mild syncope. Well it doesn’t seem mild to me, but I guess because the time between episodes is so far apart most times, thats the reason they call it that. I’m not all too happy with the notion that Each time I’m told this I’m also told I’m in perfect health. So in my mind it seems to contradict it’s self. I’d like to have a better definition but at this point I’ve kinda lost hope in finding out. Only reason I’m still after some valid answer is because I fear that my life style may cause me to seriously injur myself or someone else. Or to have some type explaination to tell people just in case it happens. Something to give them an idea of what is going on. I hope that I’m worrying over nothing,and that the syncope is just what it is. Honestly if it wasn’t for close friends and family who constantly ask about it I might not even be on here right now asking myself. Hard headed i guess, maybe the only reason I haven’t had major head injuries from the falls thus far. Seizures keep coming up but nothing ever is clearly explained.

    1. Dear Drew,
      thank you for writing into From your history you have suffered multiple episodes of loss/impairment of consciousness associated with loss of bladder control. The diagnosis of seizures remains high up in the differential. As I explained in my post, a normal EEG does not rule out epilepsy. This is because most of the times the EEG study is carried out inbetween the typical attacks. So sometimes to increase the yield of the study, we admit the patient to the hospital for an inpatient video-EEG study. The idea is to capture the typical event while the EEG (recording the brain waves) is running. Most of the times the patient is also on telemetry, meaning that heart rate and rhythm is also monitored. The video camera in the room is to record the typical event and then correlate it with the EEG and EKG findings.
      Sometimes inspite of extensive testing, the typical events remain uncaptured and uncharacterized. That time based on the history, a physician may decided to treat the patient empirically for a seizure disorder. A broad spectrum anticonvulsant is started and the response to the intervention monitored.
      My advice to you is to remain in follow up with your primary care physician and neurologist.

      Nitin Sethi, MD

  39. I have had a history of what I thought to be seizures; however, I am starting to believe that they are vasovagal syncope episodes. I have had 6 episodes.

    My first episode I was cutting a skin tag off, then felt lightheaded and dizzy. I then woke up felt myself shaking and then went back into another episode. During the second episode I awoke during the convulsing and knew it wasn’t normal. I regained control of my body within a few seconds. My third episode happened on a night I was very tired and walking to go to bed. 4th and 5th time I was having my eyes dilated. 6th time I had hurt my lower back. Each time I have felt lightheaded and dizzy proceeding each episode with convulsions. Each episode last about 15 seconds and I have always come to during the convulsing. I have had EEG’s done on 2 occasions, both coming back normal. I have also had a CT Scan and MRI also coming back normal.

    I have a feeling that I am Suffering from vasovagal

    1. Sorry pressed send too early.

      I was saying that I feel I suffer from vasovagal syncope, but am receiving no support from my PCP. She says that vasovagal episodes do not include convulsions as far as she knows and wants to proceed as a seizure and does not want to look into the possibility of it being vasovagal.

      I am trying to find a specialist on my own (since the Dr. won’t assist), but not sure if to look for a cardiologist or neurologist for diagnoses. Does it sound like vasovagal is a possibility? I appreciate your response as I am quite frustrated by this. My seizure meds have a bad side effects, so i would love to get off them. Thanks in advance.

  40. I didn’t know so many people have the symptoms I have had since I was 19. I am a 52 year old female. My spells are triggered by vomiting (like when I get a stomach virus), anesthesia, severe pain. I get a strange sensation, start to mentally fade, convulse in a backwards fashion, eyes roll back, but I also turn blue and my breathing stops and paramedics cannot detect a blood pressure or pulse. I am out 1-3 minutes. I am out of it for a time after I come to. Plus, if the family tries to touch me or move me in any way, I do physical things like jump up, scream at the top of my lungs or try to run away. They have to bodily restrain me from injuring myself. They have learned to NEVER touch me when I have an episode. I always vomit within a couple minutes of coming back. Doctors have done EEGs and said oh, yeah, vasoval syncope, but they do not seem that concerned. The episodes are VERY disconcerting for me afterward. I never know what I have done. But I have had these postsurgery and in the presence of a paramedic family member and we are sure of the no pulse or blood pressure. Has ANYONE else had these symptoms? Thanks, Susan

  41. Hi, my 25 year old nephew had an episode to today. He got up around 230am went to the restroom, he remembers feeling very hot. He says he got up and started toward the door when I heard a loud moan and found him in the doorway of the restroom. We called out his name and he responded. He was very pale. I took him to the er and after sitting there for about 30 he says he was feeling it again. Right after he said that he slumped to the left, like his whole left side went numb and he was pale and sweating. Anyways they took him back for an 1hr and a half. They took his blood work and released him. They said he had a vasovago syncope?
    What is the cause of this.

  42. I don’t know if you can help. In October I passed out for first time, took a while to come round and heart was going very fast (197bpm) when ambulance came. It then happened every few weeks, every week, every few days until it was happening multiple times a day. I have had ECGs, urine samples, blood tests etc and they have been fine. I had a tilt test and they said my heart went from 120 to 40 within a second when I passed out. I am on midodrine & fludrocortisone which address blood pressure but not the heart. The faints got less, down to about once a week but have recently been happening more and longer to come round. My eyes become very shaky, flicking very fast and my face twitching and my body can also be a bit shaky – though not always. I’m disorientated after a big one (sometimes they are only quick), very hot and just exhausted – these attacks really leave me drained. I have been told there is nothing they can do I either wait for it to get better as I get older (Dr said he’d love to say i’d be better in 2yrs but no way of knowing) or get a pacemaker which they don’t recommend for such young people. I am 21 years old, a healthy weight and I don’t smoke or drink. I have mentioned my eyes being twitchy but the dr didn’t think much of this. I also get chest pains sometimes. What if I take the decision to get pacemaker and if it is not ultimately the heart that is problem? It leaves me very slow and is really impacting my life at university and especially with graduating soon and thinking about getting a job too. I have also fell downstairs twice and really hurt my coccyx, other than the fainting when it is bad it is always a risk of injury. I wonder what you think about all this.
    Thank you.

    1. Dear Amy,
      thank you for writing in to me. My advice is always tempered since I have neither examined you nor taken your medical history in detail. As always your current doctor shall be the best person to ask this question to or seek a second opinion through him. Normally when a person moves from a sitting or a recumbent position to a standing/upright position, the heart rate and blood pressure should go up. This is achieved by a complex interplay of various factors. Some patients have an exaggerated drop in blood pressure when they change their position from a recumbent to an upright/standing posture. If the heart rate remains low/does not rise when the patient drops his/her blood pressure, the patient shall faint (suffer a loss of consciousness). This is called orthostatic hypotension. There are various causes of orthostatic hypotension: some are due to the heart and others due to the brain (neurogenic orthostatic hypotension).
      There are various pharmacological and non-pharmacological treatments of orthostatic hypotension. I would refer you to a free article which appeared in the American Family Physician (journal). I think it explains the topic in hand in a simple way. Here is the link:

      Hope you find it helpful. Feel free to write in again.

      Personal Regards,

      Nitin Sethi, MD

  43. Since July 2011 my 14 year old autistic son had “incidents” (for lack of a better term) every 3-4 weeks that were puzzling. He would complain his head ached and his speech would become slurred. Often his words would be disjointed and meaningless. His eyes would get a glazed look and he would be unable to focus on us. He would then start vomiting for several minutes. Once the vomiting ended he would go to bed and sleep for several hours. We took him to a neurologist who said he was suffering from “syncope” and didn’t seem to think it was anything to worry about. He said it “couldn’t be a seizure because he is still talking to you.”
    After this went on for several months, I called again and pretty much insisted something be done. The neurologist said he still thought it was “just syncope” but agreed to schedule him for a sleep deprived EEG, which he had this past Wednesday. Following the EEG we got in the car to go home. Within 5 minutes of leaving the hospital, my son began displaying the “syncope” symptoms–slurred speech, sweating, vomiting, etc. I got in the back seat with him. His eyes looked odd and both of them kept straying to the right. When I spoke to him he tried hard to focus on me and respond, but his eyes would wander off again. Then he went into a full-fledged seizure–his face contorted, his hands stiffened, his eyes rolled back in his head, he bit his tongue and began bleeding. The scariest part was when the seizure stopped and then started up again and finally stopped for good he stopped breathing and turned blue. We were in the car, racing for the hospital, and all I could think to do was clear his airway and start chest compressions. He began breathing again, but fitfully. At the ER he was immediately put on oxygen as he was unconscious and unresponsive. He didn’t start coming around until they put in an IV and he started to respond to the pain.
    Here is my question: the neurologist at the hospital still seems reluctant to call the earlier episodes “seizures” and left it up to us to decide whether or not to have him put on anti-seizure medication. Since I honestly believe he almost died (I know people stop breathing briefly with grand mal seizures, but I am also not sure he would have come around again without the chest compressions and the ER doc said he was “not breathing on his own well at all) we had him put on the medication. The EEG results did come back and indicated seizure activity in the left temporal lobe, but the neurologist still says that could have been brought on by the sleep deprivation and doesn’t indicate the earlier “episodes” were seizures at all. Do you agree with his opinion? Do you think we are right to start the medication?

    1. Dear Sharon,
      thank you for writing and sharing your son’s history with me. I cannot and should not comment on whether I agree with his physician’s opinion since that shall not be appropriate. I have neither examined your son nor taken the history personally. What I can advice you is this. Seizures are commonly reported in autistic children and at times can be hard to control. The EEG indicated a seizure focus in the left temporal lobe as per you. Since anticonvulsant drug therapy was initiated, keep a close watch on him and see whether his typical “syncopal like” events abate. If they do, then you have the answer you seek. His physician can then answer other important questions: how long anticonvulsant drug therapy should continue, what side-effects to keep a watch out for and so forth. So remain in close follow up with your son’s physician.

      Personal Regards,

      Nitin Sethi, MD

      1. Thank you for your response. The neurologist who ordered the EEG is now refusing to see my son and stating that the sleep-deprived EEG was “normal” and that in “45 years of practice this has never happened before.” By “this” he means a patient of his never had a grand mal seizure after a sleep-deprived EEG. This is in direct contrast to what we were told by the attending physician at the ICU–ie: the EEG showed abnormalities and the grand mal seizure was brought on by the sleep deprived EEG. Thankfully, the doctor who treated our son at the hospital is taking over his care and has, like you, advised we “wait and see” as to whether the initial incidents were syncope or seizures. So, is neurology science or art? Everything seems to be open to interpretation…

      2. Dear Sharon,
        I frequently tell my patients that not everything in medicine is black or white. Frequently you encounter the grey cases which are hard to classify. One thing which has served me well in these cases is that I keep these patients under observation. If events recur, I re approach the diagnosis with a fresh pair of eyes. Time frequently gives the answer my patients and I seek.

        Personal Regards,
        Nitin Sethi, MD

      3. Thought you would be interested to know that my son has been symptom free since he started the Trileptal over 4 weeks ago. He was having the syncope-like episodes every 3 weeks for the past 8 months, so our new neurologist now believes that these were partial seizures that never generalized until the sleep deprived EEG caused a full seizure, and not syncope at all.

  44. Hi I have stumbled across this site after a long day where my wife had her first episode in a few years. She usually has it onset from pain, striking her hand or cutting her finger, then feels faint and passes out. Usually she recovers quickly but may get a small headache and feel lethargic.
    Not a great thing when she is home alone with our 2 year old.
    This time she slipped on wet tiles and knocked her elbow and hip. She got up felt dizzy and weak so laid down on the carpet to try to stop from passing out. This didn’t work and she passed out.
    Once she came to, she thinks a few minutes, she got up and went for the phone, made it their, then had to lie down again. She passed out, in this time being out she vomited repeatedly and urinated, she was out for about five minutes according to my sister in law who got inside, let in by my two year old.
    This seems to be different from the usual episodes and we are quite worried.
    We live in a remote country town and trying to get some insight into this has been, all of her life, a pointless exercise. No one has been able to tell her what it is?
    I’ll take some of the information on this website to try to assist or maybe get some kind of help from a specialist in Perth.
    Any clues Doc?

    1. Dear Matt,
      thank you for writing to me. I am glad you found my post and some of the comments insightful and helpful. I agree that you should consult a specialist in Perth and have your wife evaluated. Why is she passing out? Is it “just syncope” or could it be a seizure disorder. If it is syncope, is it coming from the heart or the brain? I would advice that you consult a physician in a timely fashion. A few basic tests may yield the diagnosis. I send both of you my very best.

      Personal Regards,
      Nitin Sethi, MD

  45. And what if a person has episodes that exhibit signs from both? For example, I’ve fainted while lying down and regained consciousness feeling disoriented and stuttering, and was rigid during the episode. I’ve also lost bladder control in a couple of my episodes. However, the episodes are short, I feel warning signs, and they’ve been triggered by standing abruptly immediately after waking up, or by painful venopuncture (miss the vein, etc.). Medical personnel are inclined to believe it to be syncope, but I had a history of seizures as a young child (not uncommon, but warrants consideration).

    1. Dear BlueLanternBabi,
      good question and one that confronts every neurologist at some point of time. While I shall not venture to diagnose your particular episodes since the Internet is not the correct medium for that, there is an entity called syncopal convulsion also at times referred to as convulsive syncope. Here the initial event is indeed a syncope usually a vasovagal episode but instead of the patient lying down and raising his or her legs above the head, he continues to remain in an erect or sitting position. This leads to prolonged hypoperfusion of the brain and resulting convulsion.

      Personal Regards,
      Nitin Sethi, MD

  46. My 11 year old daughter has had 2 episodes recently. The episode begins with severe abdominal pain. She was standing at the bathroom counter. She becomes pale, white-lipped and breaks out in a sweat. She also feels nauseous. After a few minutes, she slumps forward with a little bit of shaking. By the time I lower her to the floor (so only a few seconds), her color has returned and she is conscious & aware. She doesn’t exhibit any grogginess or cognitive confusion. But in those few seconds, she has bowel incontinence. The abdominal pain also seems to have subsided. Does this sound like vasovagal syncope or seizure? She does not have any bowel issues (impaction or obstruction) at the time these episodes have occurred. And we still don’t know what causes the initial pain…

    1. Dear concerned mom,
      thank you for writing in to me and thank you for not using your real name in your communication. Now let me answer your question. The events do indeed sound like syncope but I am puzzled by what brings them on in the first place. That is what needs to be determined. What is the cause of these paroxysmal abdominal pain/cramping? You should bring this to the attention of her pediatrician. There are a few conditions which come to my mind but he shall be the best person to guide the work-up forward.

      Personal Regards,

      Nitin Sethi, MD

      1. Thank you for your response. Pediatrician is sending us to neurologist first and then gastroenterology after that.

  47. My daughter (15) was diagnosed with syncope a couple of years ago. She had episodes every few months, nothing very serious. Now within the last week, she has had five episodes and they have elements of both types. She has been sitting down, not standing, for most of them and sometimes can feel it coming on. She will become unresponsive and stare for a minute or two until she faints and then she is out for about a minute. Her eyes flutter while she is out and her hands shake. It lasts about a minute and when she comes to she is disoriented and does not remember the last 5+ minutes. She has had blood work and an EEG both of which came back normal. I am concerned with the increase in events. What would you suggest for our next steps? I appreciate any comments.

    1. Dear Kristin,
      thank you for writing in. Your daughter’s doctor shall be the best person to ask this question of what to do next. At times we attempt to capture a typical event on video-EEG with simultaneous cardiac monitoring. If the event happens while the patient is on the video-EEG and EKG monitor, we can characterize it better–is it a seizure? is it syncope? is the syncope cardiogenic in origin?

      Personal Regards,

      Nitin Sethi, MD

    2. We had a girl on our cheer squad tonight have this same thing happen. She is 14 yrs old. She remembers no one in her family 😦 How is your daughter. They don’t know what caused this but the fact that your daughter experienced this similar thing concerns me now that maybe this will happen again. She has never been thrown so it’s not a cheer accident but the parents are scared and your daughter was sitting and doing the exact same thing! I am very curious as to what you have found out and how she is doing now. Does she take medicine? Have the seizures stopped? Did they diagnose her?

  48. Were the eyes open or were they closed shut during the event is used at times to differentiate true seizures from non epileptic events (pseudoseizures). When a patient is having a true convulsion usually the eyes are open. On the other hand during a pseudoseizure, patients frequently keep their eyes fast shut and resist from opening them.

    Nitin K Sethi, MD

  49. hi, i was on google looking up my husband’s symptoms and i found your site. i always thought that he fell from getting too hot. he rarely falls hard mostly just goes limp and falls over. he has his eyes open but retorts of not being able to see. some times he is coherent other times he lays there and twitches. he works 7 days a week and has a very hard laboring job as a bulk order filler. he fell tonite and it really scared me this time because he drooled. it was as if he had no control of his actions. he drinks rarely smokes roughly two packs a day. has a history of drug abuse. not talking about marijuana. im almost positive this is what he has not exactly sure what type. im just very worried we can’t afford health insurance. and im wondering what i can do at home to help him if at all possible?

  50. Excellent info.I have vertigo/fainting into seizures.I see a doctor about this towards the end of May 2012,hoping to get a correct diagnosis as to what’s wrong.Hopefully nothing that can’t be managed.

  51. 17yr son, during 2nd injection to gum for wisdom extraction, sitting position , body stiffened, legs extended, limbs ridgid, head involuntary jerking to the right, eyes open rolled up, jaw clenched, face and lips purple/red/dark blue, obstructed gurrgling/moaning trying to breathe out sounds, unresponsive, lasting aprox. 3-4 mins, very slow arousal/recovery, disorientented, confused, sweating profusely, entire body completely pale/green yellow. Syncope, Siezure or medication reaction/misadministration? The dentist now wants to put him under general anesthia. I am confused and highly concerned. I am a nurse and never saw vasovagal response (dentist dx) like this before. Please advise. Son claims he was not concerned/nervous, everything fine and then he “came to”: complaining of chest pains, nausea and bewilderment. Pls advise. thankyou

  52. I have never fainted before today. I have been dieting, but nothing extreme. I had eggs this morning for the first time in 6 weeks. I admit I have been slightly constipated but thought was ok. Today I working ( waiting tables) I was fine one minute, had a slight pain like I needed to have a BM, the next next minute, I was extremely light headed, thought I couldn’t get away from my table fast enough before I passed out. Managed to get to the bathroom, extremely dizzy, and weak, had a small BM, still thought I was going to pas out, opened the door to ask a co worker help with my tables, and she said I fainted as soon as I was talking to her. When I “woke” up, I had had a loss of bowels and was a mess. Very weak, hubby came to get me……HELP!

  53. I’m 18 years old and for the past 6 months I’ve been having episodes of syncope nearly every day. The first time it happened was in January 2012. I was at work and I fainted and had to get taken to the hospital in an ambulance, and since then it’s happened at least 3 times a week. Even if I don’t faint, I feel extremely lightheaded and get the pre-fainting symptoms such as my vision blackening or closing around me, dizziness, and my hearing goes a little. I’ve also noticed that when I’m feeling dizzy I start to slur my words a bit or not be able to form my sentences properly. I feel the most dizzy when I’m under bright/fluorescent lights. My doctors have noticed that when I’m standing up my blood pressure drops and my heart rate increases.

    I’ve had blood tests, urine tests, ECGs, X-rays, etc, but doctors have been unable to diagnose. Their recent theory is that these are actually mini-seizures that cause my episodes, but I’ve never heard of anything like that. I’m 18, isn’t that a little late for something like this to be coming on? I’m going in to get an EEG and they’re going to try to induce an episode while monitoring my brain.

    I just really hope they figure this out soon, because it’s taking over my life. I can’t work very often because it’s not exactly helpful to be passing out on the clock. Does anyone have any similar stories or advice? I’ve never heard of anything like this coming on at my age and my doctors seem to be confused too.

    1. Dear Maggie,
      I am sorry to hear what you have suffered. A EEG study with simultaneous monitoring of your cardiac activity shall help clarify the diagnosis. The trick though shall be to capture a typical event while the EEG and EKG are running. I wish you good luck.

      Nitin K Sethi, MD

  54. I’m 23 years old. I was standing outside yesterday and all of the sudden blacked out. From what my boyfriend said (who was with me when the incident occurred) my eyes were wide open. I didn’t blink and I stopped breathing but had a pulse. When I was coming to, about five minutes later, I felt like I couldn’t talk. I recognized my boyfriend but didn’t know who he was. After I got up I started to shake uncontrollably. It took around two hours to actually realize what had happened. I couldn’t understand what was going on?

    1. Dear Mikka,
      thank you for writing in. My advice is to bring this to your doctor’s attention. As I stated in my post, a few simple tests shall help determine what happened.

      Personal Regards,

      Nitin K Sethi, MD

  55. Hello Mr Sethi,

    My brother aged 18 had a fainting episode two days ago. He told me that after going to the toilet he was half way down the stairs, he felt a slight pain in his chest, his vision went grey and he blacked out. As he did he fell into the front door. When he came round thirty seconds – one minuit later he realized he bit his tongue. (his not sure if this was because of the fall or fainting episode?). When he came round, he was verbal abusive to my father and unsure why for a short time.

    I had a uncle who had heart problems, and died of a heart attack in his 40’s so could this be connected in someway?

    He has been to the doctors who have decided they will run blood tests to determine the cause.

    My question after reading your causes and symptoms etc, as this could be a hereditary thing maybe? Is that shall i get him into more exercises that increases his heart rate for a short time after he has been diagnosed?

    He is a healthy individual by weight, slim build and plays golf regularly.
    I will ask the doctors the same thing but after he has been diagnosed, what is your professional opinion on maybe getting him to do a few more demanding physical exercises’s to up his heart rate and maybe strengthening it in doing so? (if this fainting episode results in being connected to his heart)

    Thanks very much for a very informative piece as well.

    thanks Chris

  56. my daughter is 10 yrs old yesterday my son stepped on a huge piece of glass and needed stiches i had my daughter with me she was acting fine when they started stiching my son (she wasnt watching ) i heard a weird sound behind me i look and see my daughter slumped over in her chair her eyes rolled back and she was curling her hands in my husband put her on the floor as the doctors orders and she instantly woke up she didnt seem confused just complained her stomach hurt remembered feeling a little nausous before fainting the doctor in the room said she fainted from the stress of the situation and not to worry it looked like a seizure because she was sitting and not standing my husband feels in was a seizure because of her hands curling inwards ive made a neurologist appt but would like to sleep tonight im a nervous wreck thank you so much for your time

    1. Dear Nicole,
      from the history you provide me, I feel that likely your daughter suffered a syncopal episode (fainting episode). In medical terms we refer to it as vasovagal syncope. That said you should follow her doctor’s attention and follow up with the neurologist. He shall be the best person to determine the underlying etiology of the index event. Good luck.

      Nitin K Sethi, MD

  57. Hi,

    My husband has been having these attacks for about 3 years now. Very frightening but the Dr. Said it was because he was overweight which I struggle with. He isn’t that big. Anyway this normally happens when he is dropping off to sleep. He can sometimes stop it happening by doing breathing exercises but when he can’t he has to sit up as he is failing to breath. His face seems a little squewed and he is having some body jerks or spasms…he is fully alert and aware of what is happening as most time he taps on me to wake me up. I get up and get a towel to catch the drool. This can go for 20-30 seconds or more or less…it feels like it goes forever. Then he makes a smacking sound (mouth), as though getting back saliva and distributing it in his mouth. He speech doesn’t immediately come back but within a minute/two he can talk bt his speech is slurred.

    I have looked everywhere on the internet but have never asked an expect…we have not gone back to the Dr for a while. Any suggestions to what this could be???

    My husband drives about an hour to work could be longer if he is caught in traffic. He sometimes struggles to sleep at night.

    Please help us understand what is happening????



    1. Dear Bee,
      while I cannot and should not attempt to diagnose him over the Internet, there is a possibility that your husband may be suffering from obstructive sleep apnea. I advice that you bring this to the attention of his primary care physician. An overnight sleep study can be carried out to rule out or rule in obstructive sleep apnea. Of course other diagnoses remain in the differential and his physician shall be the best person to guide the workup forward.

      Nitin K Sethi, MD

      1. Thanks for your advise but having looked at obstructive sleep disorder I thought this happens when the person is fully asleep and they are not aware it is happening??? Hence why I thought of asking you because you seem to be very knowledgeable about these sorts of things. Any other ideas???? I’m willing to read up +++ before we present to the doctor again. Just the other night he had another attack and this time he dropped off to sleep and was woken up by a vibrating feeling and sound and it turns out it was him???? I work nights so wasn’t at home when this happened.

        So grateful for your help and suggestions.



  58. I am having these weird episodes and curious what you think. Sometimes I get dizzy and my vision starts to narrow in and get black. I get woozy but I am able to catch myself and never pass out. Other times I have no feeling of anything. Sometimes I’m sitting at a table and sometimes I’m walking. I go from being fine to waking up on the ground. The most recent episode I woke up an hour later in a pool of vomit and pee. I went to the ER and they did an EKG, chest x-ray, labs, brain CT, and brain MRI. All were normal. However, ever since I have just had this constant tingling feeling in the back of my head. I also just feel stupid. My brain doesn’t seem to be connecting with my mouth and I forget what I’m saying mid sentence. Since sometimes I feel it and sometimes I don’t what’s your opinion on syncope versus seizure?

  59. Hi, just stumbled upon this in my googling while trying to get more information on what happened to me. It seems that my symptoms fall in both categories according to your article. Might be worth mentioning (or maybe not) that my friend who was with me is trained in CPR, and he said “I know a seizure when I see one,” though I understand syncope can be easily confused with seizure.

    Recently I was out playing tennis when I went to get a drink of water along the fence at the court. I started to hear or sense a sort of loud humming in my head and a sort of muffled strange voice (which I assume was my inner monologue) telling me “you’re going down.” I grabbed the fence and eased myself to the ground (as mentioned above), though still did scrape my face a bit. My friend who was there with me said that I then proceeded to convulse. I bit my tongue during this episode (drew some blood), though not as badly as had happened the other time I had a similar episode (more on that in a minute). My friend also said that as I regained conciousness, I kicked off my shoes (which were on very tight), and was very disoriented. I have a vague recollection of first regaining consciousness, and I was confused. An old teacher of mine was nearby and asked if I knew who he was. While I recognized him after a bit of initial confusion, this part of the episode still feels to me like it was dreamed. I was taken to the ER where I began to feel completely normal again before seeing a doctor. The doctor did a few reflex/pupil tests and asked a few questions before deciding that this was VV syncope. I asked if it could be brought on by dehydration as this was a common thread in both episodes I’ve had, and he said that it may be.

    The other time this happened, I was cleaning a bathroom when I began to feel light-headed and had to support myself up against a wall. No one around this time to tell me if I had any tremors or anything, but I experienced the exact same disorientation/confusion where I felt like I was in a dream state afterwards. I encountered a friend shortly after outside of the room I’d been in, and told her I didn’t feel well. She told me to get a drink of water and I felt as if I was sleep-walking as I followed her instructions without question. This occurred while I was working at a hostel, and someone had to take over my work shortly after this, but it turned out I had taken all of the cleaning supplies and put them in the corner of my bedroom, almost hidden. This part strikes me as especially bizarre. In this episode I bit my tongue extremely hard so that it drew blood and hurt for days afterward. No hospital this time as I was overseas and didn’t think much of the episode as I returned to normal later that day.

    Common threads between the two episodes: a feeling of light-headedness before, a feeling of disorientation afterwards as if I were dreaming rather than awake, biting my tongue (though in both cases I didn’t realize I’d done this until much later when I felt pain there and looked in a mirror). In both cases as I shook off the fuzziness, looking back at each episode felt like it was a dream rather than a real occurrence.

    Sorry for the long-winded explanation, but I am just looking for your opinion on this based on the details. Any comment is greatly appreciated. The ER doctor wrote off epilepsy/seizure, though he did little more than have me follow a pen with my fingertip.

    Thanks a lot, I look forward to your reply.

  60. Would it be possible for you to elucidate briefly on what you mentioned with regard to convulsive syncopes, which begin as a syncope and become a seizure? I have been told for many years that I simply faint, but there is very rarely a trigger like heat or shock, and it happens when I am lying down/asleep. I convulse but do not become incontinent or bite my tongue. This has been happening to me for nearly 10 years; I am a woman in my early twenties. It would be interesting to know more about this issue you mentioned in point 4 of your syncope list seeing as my symptoms are so mixed.

    Thanks so much as I would find even a brief explanation very interesting. The article has already been of much help clarifying the two episodes.

    Hope you’re well, and thank you so much for your time.

    1. Dear Emily,
      thank you for writing in. I shall be happy to answer your question. Syncopal convulsion also at times referred to as convulsive syncope is exactly what the name suggests. The patient suffers a convulsion (shaking of the limbs, loss of consciousness, at times tongue bite and loss of bladder control) of that there is no doubt from the history (obtained either from the patient himself or from witnesses) but what lead to the convulsion is where the money lies. The convulsion is triggered by a syncopal event (usually a vasovagal syncope which leads to drop in blood pressure and prolonged hypoperfusion meaning decreased blood flow to the brain). It is important to identify these patients accurately and in a timely fashion since the treatment is usually reassurance and not long term anticonvulsant therapy.
      Hope this helps you. Thank you for asking about me. I am well and at present vacationing in New Delhi spending time with my parents and catching up with some old friends.

      Personal Regards,

      Nitin K Sethi, MD

  61. My husand reported not feeling well when we were out for happy hour yesterday. He had a crabcake and a few bites of smoked tuna which his friend thought was “bad” Within about 20 minutes of eating he was cold sweating and disoriented. His face was turning blue and his body became rigid but no convulsing. People helped me get him safely to the ground. He was unresponsive. We turned him on side and moved his tongue out of the way so his airway was clear. We could not get a pulse on his neck because he was so rigid. He lost bladder and bowel control. After about 2-3 minutes he started to come around. He was disoriented but all the color had come back into his face. All tests have come back totally normal. Artery check, EEG, MRI, CT Scan, Bloodwork. He has no history of syncope or seizures. We live in a small town with a tiny hospital and I am just wondering if there is something they missed with testing.

    1. Dear Angelafrommd,
      it seems your husband suffered a syncopal event. Please maintain follow up with his primary care physician and make sure that cardiogenic and neurogenic causes of syncope were systematically looked for and eliminated. To rule out an underlying seizure disorder sometimes a longer EEG study (ambulatory EEG study for 24-48 hours or an inpatient video-EEG study is extremely useful).

      Personal Regards,

      Nitin K Sethi, MD

  62. Dear Suzanne,
    you ask me a very open ended question and with the limited information you provide me, my advice is tempered. Various differential diagnoses come to mind.

    Nitin K Sethi, MD

  63. My mother has dementia and is under hospice care. She does not have a history of seizures but I believe she had a seizure a couple of weeks ago and also a couple of focal seizures. Today she had convulsions then followed by a loss of consciousness. The nurse was not able to get a pulse when she first arrived. they were calling it vasovagal syncope, but the convulsions she had before losing consciousness don’t necessarily fit with that does it? Thank you!

  64. Dear Dr. Sethi

    I came across your blog while trying to figure out the cause behind a fainting spell. Two days ago, I was sitting at a restaurant when I began to fell dizzy, lost consciousness and fell on the floor, even though I had put my head on the table a few seconds ago. Initially I assumed it was because of low blood sugar- it was late in the afternoon and I hadn’t eaten since morning- or too much sun. However, later my friends told me my eyes were open the entire time, and I also lost bladder control. I have fainted before, but never with my eyes open, and I have also never lost control of my bladder while being passed out. I haven’t visited a doctor yet, but I’m concerned. What do you think this could be, and do you think I should visit a doctor?

  65. Doctor-
    I just was diagnosed with what they called a “vagal” episode. Basically, I started feeling nauseous, dizzy and kind of warm, so I stood up and within several steps, I lost control of my entire body and fell to the floor. I felt like I was conscious the entire time which only lasted what seemed like 20-30 seconds, but I lost my vision briefly and could only see bright yellowish-orange light. Within seconds (could be longer,) I gathered myself and stood back up. My body temperature went up, and I began to sweat a lot! Thankfully, I had an ice pack in the freezer to put on my neck. After several minutes, I regained my composure. I believe I also had to have a bowel movement. I noticed someone else also mentioned this last part.

    After going to the ER and dismissing cardiovascular disease (stroke/heart attack) and diagnosing it as a “vagal” event, I still have a low grade headache, (and it is now five days after the event,) plus I have a fuzzy-feeling sensation from ear drum to ear drum and also in the jaw/cheek/neck area. Throw in a little nausea. If I haven’t eaten or drank anything for a while, it seems like the nausea is more pronounced. It has only been a few days, so I am still piecing together my symptoms.

    My question is are these symptoms typical after a vagal episode: low-grade headache, fuzzy sensation from ear to ear and in jaw area plus nausea?

    I am getting a full physical and will be describing everything written here to my PCP later on this week, but I was just wondering until then.

    I keep wondering if there isn’t something more to this or if something more serious caused it. The headache is one thing but this fuzzy sensation plus nausea is disconcerting. I tried to drink a glass of wine, and the nausea increased.

    I hope to share my findings to this thread. If there’s any input about my question above, then please let me know.


  66. Just made a post but shortly afterwards I fell onto a revelation while talking to a friend. He said he had the same symptoms as I do two years ago. It turned out it was a gall bladder attack–which causes fainting. My right abdomen does have intermittent pain (very mild) with some pressure.

    I am going to be sure to tell my doc to consider this, too.

    Stay tuned.


  67. Um. Okay so here it is: I’ve have “passed out” twice in my life. I’m only sixteen. The first time was a few weeks after i turned eleven. I’m not exactly sure how long after it was but i had had surgery on my feet before this happened (a few days before i passed out most likely). My mom was helping me shower and i started to feel like my stomach hurt. I finished and got out. The last thing i remember is that i was sitting down and my mom was brushing my hair. Then I was out. I don’t know how long i was “out” but i remember dreaming and As i came to i remember hearing my mom and then having an accident and wetting myself. I was confused when i opened my eyes and was scared because i couldn’t understand why my mom was in a panic. She said that i was in the sitting position the whole time and that she didn’t know i passed out until i sort of grunted (not the right word but i think she means i was struggling for air???) because my chin was against my chest (blocking my airway?). I was taken to the ER where they did a EEG i think and took blood etc but the doc said he didn’t know what caused it.
    The second time was when i was fourteen. I had just gotten home from getting my wisdom teeth taken out and was in the kitchen at the sink drinking water. The last thing i remember is that my stomach hurt and staring down into the sink. Then i was “out” again. I remember feeling myself hit the back of my head on the cabinet but i didn’t come to until i felt my mom saying everything was okay. My head hurt and i was hot, i felt like i was burning up. My mom says it was adrenaline. Still confused, she helped me sit down on the couch.
    My pyscology teacher says that you don’t pass out backwards, that to protect itself, your body falls foward and that you are completely relaxed when you pass out. The second time i passed out, i passed out backwards and my mom said i was extremely stiff, like in cartoons how the characters stand straight up and roll back on their heels, sort of like a bowling pin if you get what i mean. My mom also said that i had my arms pressed against my chest and that i was shaking. Were these episodes syncope or siezures? My mom has a theory that i pass out as a way to deal with pain but there have been several other opportunities that i didn’t pass out for and my curiosity is driving me crazy.

  68. My daughter is 4 years old. She had two episode of unconsciousness in last two months. Both occurred while she was asleep and she was on Salbutamol for cough. First episode, she was just sit down from sleep to cough and became unresponsive for 5 to 6 minutes. Her eyes were wide open and her body was relaxed and there was no movement. We ran water on her head. After 5 minutes she said please stop watering and she went to sleep. In second episode she was asleep and wake up for vomiting then she became unresponsive. Her eyes were wide open and her body was relaxed and there was no movement. After 5 minutes she become responsive and we asked for drinking water, she drank water and slept again. Her EEG was normal. So, how to confirm she has epilepsy or not?

  69. i am curiou what would be causeing my eyes to blackout (my husband said they went to the back of my head) then my body starts shaking. it has only happend a few times in the last 7 years or so but i do blackout kind of frequently. it is always shortly after standing up. could this cause brain damage? i have recently since my last shaking episide have been slurring my speech and forgetting what im trying to say mid sentance… also i had a doctor diagnos it once and said it was just my blood pressure dropping. and he said to drinkmore water so i have been. it is still happening.

  70. Dr Sethi,
    I am a 28 year old female and I had an incident last night that was extremly freighting. I got up shortly after laying down for bed because I decided I should go to the bathroom. When I stood up to go to the bathroom I suppose after taking about 8 steps ( this information has been relayed to me) I fell over and hit my back on something ( I was also told right before falling I called for help). I remember thoughts about being snapped in half because of back pain but not being sure why my back was hurting. The next thing that I remember happening was being out in the hallway of the house trying to say stuff but I couldn’t get any words to come out and I could not get my limbs to work (I was told they seemed very limp) around this time I managed to say I had to use the bathroom and apparently around the same time I lost bladder control. I was then taken down to the bathroom where I was placed on my feet and then collapsed again. I remember my boyfriend panicking while he slapped my face and asked me what to do. He kept telling me my face was ghost white and my pupils were huge and my eyes were not moving. Shortly after thinking in my head I was going to die I began to regain some control of my body but had no recollection of my initial fall and most details in between remain sketchy. My boyfriend did not call 911 instead I went to sleep for a while and then made a doctors appointment in the morning. My doctor told me to go to the hospital right away (I have no insurance and he thought I had a seizure and was afraid if he ordered tests I would be refused the services I needed) I went to the ER and was told it was Syncope. The Er doctor ordered blood work, urinalysis, an X-ray of my spine, and an ECG. The tests came back normal and I was told I can not drive until I follow up with my physician and we can figure out what the cause of my “Syncope” is. I have no insurance so more medical tests seem out of the question but I would rather not fall and injure myself all the while losing control of my limbs and bladder. Should I assume this is not going to happen again and this was simply a case of syncope (which I have experienced before I think. I can’t take showers because my face starts to feel all prickly and I get spots in front of my eyes and must sit down of I am sure I will fall down. I also had two incidents in the past three months that I am confident were syncope but was aware that I felt ill and eased myself to a sitting position ). I just have never experienced anything like this and it seems odd that my body would do that is everything is fine. Oh and also I had gestational diabetes with two pregnancies and am curious if I may have blood sugar problems that could cause something like this.
    Thank you

  71. My boyfriend had an incide today and I’m trying to figure out what it may be he was washing dishes when his hands locked up he stated he needed to step outside which he did when he retuned back inside he wrapped his arms around me where I continued to hold him he was speaking in a monotone voice asking me to continue to speak to him took about sixty second before he came to and was ok I’m scared and don’t know what it could of been it slightly reminded me of a seizure but I’m not sure looking for advice before we seek medical treatment this is the first time this has ever happened sincerely worried girlfriend

    1. Dear Tarra,
      I am unsure what to make of this momentary lapse of awareness that your boyfriend experienced. While a seizure remains in the differential the episode seems unusual. I would bring it to the attention of his primary care physician and see what his advice is. A EEG can be carried out though I doubt its yield.

      Nitin K Sethi, MD

  72. My husband was medically discharged from the military with “passing out” spells. While in there the only test that ever showed anything was the tilt table test. 13 years later he goes thru periods of being fine then months of “passing out”. He is on no medication and hasn’t been for years. I don’t believe that it is only fainting spells. He falls hard sometimes and sometimes he wilts…we are so confused on what is going on. He does wake up disoriented and confused, he is stiff and jerky during the episode. Rarely does he lose his bladder but has a couple of times. He also appears to quit breathing during his episode and then finally will gasp for air as he starts coming out of it. He also has horrible headaches with these episodes where he will have to lay in bed for days until they go away. It is very scarey. We have lived with this for so long…could it be both syncope and seizures?? Any thoughts would be appreciated.

    1. Dear Suzanne,
      thank you for writing in to me. Your husband’s case intrigues me. Since he was medically discharged from the military, I assume he has already undergone a thorough investigation for these episodes. My only word of advice-at times it does not hurt to have a second physician look at him with a fresh pair of eyes. These episodes (especially) if frequent can be captured on a video-EEG machine with simultaneous monitoring of the heart rate and rhythm and blood pressure. Whether they are seizures or syncopal episodes can then be determined.

      Nitin K Sethi, MD

  73. Hello,
    The other night me and my boyfriend went to a wedding and consumed a large amount of wine. We went home and went to bed. In the middle of the night i heard a loud thump and unusual breathing/ choking noise. I found my boyfriend face down unconscious. I turned him over calling his name and he came to. He had gotten up for a glass of water, the water was spilt on the ground one way and he was laying on the ground the other way. Do you think he had a seizure or just passed out? This is the second time something like this happened but I first time I wasn’t there to witnesses it. Thanks for your time. – Brice

  74. I m suffering from seizures from last 15 years,1st episode came at the age of 15 years,during that time i was in fever and i got up from the bed and passed out. The episodes like this off and on continued for long, finally at my age of 23 doc in india prescribed me depakote 1000mg/day which kept me well controlled, nothing triggered me. Earlier short sleep duration,over stress ,headaches,odd schedules and less dose used to be the reasons of all the episodes. Every time all MRI,CT Scans,EEG were normal, so doc decided to wean off my medicines after completion of 3 years of continuity. During this time i got married and gave birth to a baby boy with little complications but all went well. While weaning off the medicines i used to feel heaviness while standing suddenly, a kind of pressure used to hit my head all of a sudden nd sometimes i used to have complete blackouts too thinking it off medicines problems i ignored. I was on depakote 250 mg and one fine morning i got up and the same kind of episode triggered again(My whole body stiffens up, foam comes out and i scream hard and shake too this lasts for 2 minutes and i get back to senses after total of 5 minutes but take time to know where i m),during this episode i was in states they took me to ER did all the required test and all came normal so after one more same episode doc here prescribed me Levetiracetam 1500mg/ day keeping in mind my child bearing age.But no fullstop,i still have seizures in every 4 months reason is same ,when i wake up from the sleep whether its morning or noon, in major cases either i am awake all night or after travelling due to stress and time change it triggers.My doctors here thought its not epilepsy and asked me to go for Tilt table testing which came positive.Now they firmly believe that i m suffering from Neurocardiogenic syncope and they suggest me to take in more liquids and salt and slowly-2 stop all medicines, but i somehow do not believe as i have gone through so much and also do not have confidence to leave the medicines .Depakote made me seizure free for good three +years in which i got married ,delivered a baby boy all went smooth accept my pregnancy was little risky,now keppra-1500mg/day made my condition worst,in daily basis i always feels a kind of pressure and heaviness in my head, while sitting and getting up suddenly or changing positions this pressure hits hard and thruough my ears i can hear a kind of tight air in side or something very odd,its gets calm when i keep my self really calm and stable for a min.every change in routine makes me fearful and m scared too.But we have not reached to any conclusion whether its epilepsy or neurocardiogenic syncope its getting more complicated and doctors in states have standard reply to all questions, what should i do next … I am thinking to start homeopathic too. I need ur help in this …. please guide me, hoping a reply from you soon.Thanks for reading.

  75. I have read your explanations but still am not certain where my experiences fall. I have passed our four times in the last two years or so. Twice while donating plasma (understandable), and twice while seated on an airplane. In all four instances I was dizzy before fainting and knew I was able to pass out, I lost bladder control, there was a tremor in my left hand (as reported by witnesses), and I was confused for 5-10 seconds after regaining consciousness.

    One of the airplane events was in the air, the other on the ground. In the latter, they took my off the plan and to the hospital….three days of tests (cardiovascular and neurological) and nothing was found. It Happened on a plane again today.

    Strange as it may sound, I believe the airplane instances are related to the airplane seat somehow affecting my circulation. At any rate, two instances on a plane (no anxiety…flown 100 or more time, one on the ground, one in the air) is not likely a coincidence.

    i am a 51 year old male in good heath. Any thoughts?

  76. My daughter is 14 now, but has had episodes since the age of 4. She had had EEG’s done and each time no seizure activity has shown. She can tell when the episode is coming. She feels funny in her stomach at first, she has been sitting in class, and just fell to ground. She can be standing, walking, or just sitting down. People who have seen it happen say her eyes roll back and she has slightly convulsed. Her recovery is confusion, and extreme fatigue which can last for a day or more. When she had the episode at school she was not right for about 3 days until she was her normal self. When she gets that feeling in her stomach, she will lie down, sometimes the feeling will pass with no passing out but she will again be very fatigued & sleep for hours afterwards.
    Many hospital, Neurology, Cardiology, EEGs, echoes, EKGs, & blood test have been done. Everything has always been cleared. We have been told just to watch her with no sure diagnosis. One EKG showed a prolonged Q-T wave, again many test done and we were told vasovagal syncope. That time was the time it took her about 3 days to recover fully. That episode happened in September while at school, we are now in Nov. and she has probably experienced these episode the most. Since Sept. she has probably had 2-3 episodes with no passing out but with a feeling of extreme fatigue & again the need to sleep it off. She has never urinated on herself.
    It seems to me that she is having some kind of seizure due to her recovery time. But all we have been told is syncope.
    This past week on Tues. she complained of being really tired and just wanting to sleep. on Thursday she had the feeling in her stomach but didn’t pass out. She has had a headache off and on for 2 days but didn’t tell me that until going to bed, and the feeling of being here but not being here.
    The last neurologist told us if she does not have a year without any episodes she will not be able to drive.
    What is your opinion or advice regarding my daughter?

  77. Dr. Sethi, I have been on many forums to try and figure out a diagnosis for my “Episodes” I am at a bit of a loss because most people that suffer from this either have one or the other but not both of my symptoms. I narrowed it down to Defecation Syncope with my symptoms of stomach cramps, sweating, Diarrhea, Pale, Feeling very faint like. MY added bonus symptom is that my hands begin to curl in.. (not like a claw, but more of like a fist with my thumbs inside) and my feet begin to curl in. I have appointments for a cat scan and a few more tests that the neurological doctor requested. He thinks i might be having seisures. But that doesn’t explain the “restroom” part of it all. And is it my supposed seizure that is causing my stomach pains and have to go the bathroom or.. is it the extreme stomach pain i am in that causes my seizures. I have only fainted Once and when i came to, my knee’s locked up I couldn’t get up..then all my muscles in my entire body went into spasms/cramps. Besides that episode 15 years ago..i have not had any fainting but just the restroom incidents with the hands and feet curling. Please help me figure this out or atleast give me some ideas of what it could be so i can present it to my doctors. I thank you in advance for any help you can provide.

  78. This morning i fainted for the first time ever after drinking alot of alcohol last night i woke up thirsty and went to get water and i felt severly dehydrated and hung over and before i knew it i collapsed and was out for about 3 seconds and woke up knowing i passed out and what happened. Is this normal? Also im only 19 and if it matters ive been constipated the past week. And had to have a BM afterwards. Its just weird because ive drank this much before and have been way more hungover and not fainted

  79. Hi I am writing for the first time because I have a question that I am hoping someone can answer. I myself am an epileptic, so is my mother and I lost my sister to a seizure, so I do have some knowledge on the subject. Today my husband scared me and I am confused and wondering what to do. We were driving and my husband’s head dropped to his chest and he started vomiting all over himself and even though my son and myself tried to get a response from him he was unresponsive for approximately 1-2 minutes. I pulled over and he was confused and finally got out of the car and tred to stop the vomiting. He later told me he didn’t remember crossing the bridge that we crossed about 3 minutes before the vomiting started. I am afraid he had a seizure of a sort and yet he won’t go to the ER to get himself looked at. Do you have thoughts?

  80. I have recently received a positive tilt table test, but it is more complicated than most as I go into a convulsion. These episodes began at age 12 and have continued until now, and I am 55 years of age. After having staples put into my skull from one of the last episodes and passsing out on a city bus; going by ambulance to emerg both times, it got to be that I was afraid to do much of anything or go anywhere. I also PTSD which made the doctors think that I was just stressed; that is, until a neurologist observed me faint and convulse right in front of him. I have now been referred to a specialist who deals with complex cases of syncope and must travel out of town to attend. I have never even tried to get a driver’s license for fear of having an episode. I seem to have a long warning period, where I feel like something is just not right. So I gulp water, eat something, pray and muster up all the courage I can to leave the house. Needless to say, I have had these episodes all over the place and have suffered over 200 episodes in my life. Because my life story is so complex, doctors believed that it was all in my head (pardon the pun) So it is rather a relief to finally have someone believe me. I have suffered intense anxiety, panick attacks, social phobia and this has remarkably altered my life in a very negative way, as I could never be certain one day to the next whether I would be pulling a funky chicken! Currently I am on 0.5 mg. clonazepam twice daily, 100 mg. gabapentin and 400 mg. Fluvoxamine Malate. As well, at the EEG, there shows a slight slowing of brain waves on the left side of my frontal temporal lobe, while the MRI shows many white legions, that they were not certain what they were. I carted around a loop monitor for a whole month this summer and it was unremarkable. One thing I wanted to ask is: Is there any relationship to sudden death? The reason I am questioning, is that I had a baby boy die of SIDS in 1990 and the autopsy report said that it was Sudden Infant Death Syndrome. I have always wondered if there is a correlation somehow, or whether any research has been done on this? I have so many questions and so many stories of sheer embarrassment.

  81. I am a 54 year old female, relatively healthy with seasonally allergies & under active thyroid, that has had 3 fainting spells in the last 3 months. These happen when I am standing & /or walking for a long period. Prior to these 3 episodes for a couple of years I would have a metal smell, feel dizzy, hot but did not pass out when walking around shopping, I had time to sit down & this would pass. The first one happened when standing in line at a cash register at Walmart after being there an hour or so shopping. I had the metal smell, felt tired, hot, dizzy & lightly nauseated. I then woke up to people standing around me. I passed out for just seconds, I did wet myself, I hit the back of my head & my butt when I fell but was not confused & was able to drive myself home. A week later I was with a friend at Sam’s. We had been walking around shopping & all of a sudden I felt tired, hot, nauseated. I was out again for just seconds (did not wet myself) but took me a second or 2 to recognize my friend. I hit the side of my head & my hip & leg when I fell. Today (a few months later) I was at Burlington Coat Factory standing in line at the cashier, I told my boyfriend I didn’t feel good, felt hot & nauseated, as I leaned against him, he said he felt my knees buckle. He kept me from falling by easing me to the floor. This only last seconds I can hear people talking to me but is very embarassing & scary. I have seen my family doctor & a cardiologist. I have had an ekg & an echocardiogram to which nothing showed up. The cardiologist thinks it is caused by a drop in my blood pressure, he has told me to sit down when I feel this coming on, but the problem is when I feel like this I only has seconds before fainting. I go back to see the cardiologist in a few weeks. He discussed running more tests like a tilt table if this continues. I would appreciate any thoughts on what could be causing this.

  82. Hello,

    I am trying to get some answers as to what happened to my husband about a week ago. We were in the mountains packing up our camp when my husband said he didn’t feel good and went to sit down in the drivers seat. The next thing I know I hear him breathing very heavily. I walk over to his side of the car to see if he is okay and his face is white as a sheet, his eyes roll back as his head falls limply against the headrest, and he is not responding. He doesn’t display any signs of shaking. He comes to within a minute and doesn’t display signs of confusion. He is shaking and says he feels weak. He then informs me that he is wet (aka he peeped himself). We don’t have medical insurance but went to a cheap clinic. We left without any answers but they did an EKG and said his heart seems fine. Since the incident my husband has had more labored breathing and moments where he feels like he may faint again but doesn’t. He is a healthy, 28 year old male and I don’t think doctors take it seriously because they look at him and see a healthy man. Can you give us any indication of what this could be??? thank you!

  83. Please help. We have been to the emergency, to the best cardiologists available and I have been researchibg on the internet to no avail and we need to have some clarification or direction.
    It all started last May in a lovely japanese restaurant where we had just started the meal with a miso soup. Suddenly we noticed my 78 year old grandma was not responding. Her eyes were open, her head ever so slightly down and her hands normally on the table. She would try to respond and her mouth was open but ot would only move a little bit. She was sweating profusely and breathing heavily. Her eyes were open, frozen and lighter than ever. We laid her down on the floor and she would come back for a sec and then be gone again. When she finally returned (+ or – 10 minutes), my uncle, on the other side of the table started havinh the same symptoms. It lasted about three minutes with him. My grandma noticed she had had an intestinal discharge which my uncle did not have.
    They were taken to the hospital where all kinds of exams were done as they were in Intensive Care for four days, however nothing was found.
    Against my will, we have been to this restaurant many times again and nothing happen to them or antone else. Until yesterday. We were standing to leave afterhaving a very fun and lively meal and noticed my grandma was not standing. Until then she had been her energetic lively self ( she is a 78 year old who works out every day, looks 65 and has a weekly beer with friends). She had had a sale, but was completely sober and she has sake frequently when having japanese. But to my shock she had gone to the same state. Sitting normally, head slightly down, mouth a bit open, eyes open and nowhere and sweating. While waiting for the ambulance, we tried a little bit of talking a little salt on her mouth, a little alcohol for her to smell, she started vomiting still unconscious. She was breathing heavily. Suddenly she stopped breathing. I desperately asked help to lay her down to try to do some CPR. As she was being laid, she came back completely. Her talk was ever so slightly blurred.
    Please help! I don’t want this to happen again. I need to know how to proceed. And it has happened twice more: once in a my mother’s dinner table and once while she was working out (but no diarrhea, breathing problems nor vomit).
    The doctors have no clue, they say it was simply a syncope, but that is not the right diagnosis, I am sure. Please help. She is a very lively, otherwise healthy and beautiful woman who everyone was always sire she would live until 100 years of age.

  84. hi,

    I’m from Kuala Lumpur, Malaysia and I’am a Hindu and age 26.
    Regarding attacks … i had some yesterday 17 Jan 2013 and the last attack was 3 years ago.
    It started as sweat and followed by heat attack , lack of vision , then entered the black- out session but i force to myself to stay conscious due to i was on the road side and alone …but at the same time i felt like my body is ready to pass motion …..what i did next is move my hair from front to back get some air as i was sweating …next i unbuckle the bra and my pants until i can breath and finally sat down …. That’s the moment i get everything back to normal …but the dizzy was there with me till night. I got up this morning feels like my head and body is very light and physically weak . What happen to me and is this Syncope and what kind of medication should be considered.

  85. i think i had a sezuire but i’m unsure mybe you guys could help?…. i was walking my dog felling good and next thing i know i have woke up on the a walk path and i’m feeling very very disorientated and couldnt remember what had happend i then try to get up but coulnt for about about 40 seconds. i stand up and i feel quite sick so i walk home within about a half hour i have a banging sore head that lasted for about 24 hours. next morning i awaken and my muscles in my neck and stomach are very very sore as if i had been working out for hours the day before and for the next 2 or 3 days i felt exhusted and had no energy.
    my dr thinks it may be a sezuire but doesnt know so i have to wait on appointment at hospital but thought i would write in to see what other people think happend to me. one thing i am sure of is that something happend to me that night it was not me fainting this i am sure of but let me know you thoughts guys it would be of much help

  86. Thank you so much for your useful information. My daughter had a febrile seizure when she was about 3 years old. Since then whenever she gets the flu, which is about every 3/4 years, she faints. She was weak each time from fever on her way to the bathroom and occurs in the bathroom right before or after urination. This is very scary for me because soon she will be going off to college and I won’t be there to catch her when she falls. My husband wants her to start getting the flu shot, but I am skeptical about vaccinations and would welcome anymore information or another route to take. I appreciate your help.

  87. Recently while spending some time with a family friend and her neighbor, we started talking about throwing up (i had been sick the week previous to my visit) all the sudden the neighbor (she’s 19 or 20) stands straight up and says “I think i have to go” Then she grabs a hold of my friend and loses consciousness . Apparently thinking about anything gross causes these “attacks”. She lost consciousness, her eyes rolled up into her her head and deviated slightly, and she lost bladder control. She did not convulse but it definately looked to me like a seizure. I have had Tonic Clonic seizures since I was 10 years old. Since this happened i’ve offered a listening ear to the girl because I understand better than most what it feels like. I have been trying to research triggers though because that seems like an odd one. Have you heard of anything like that?

  88. When you have a seizure, right before you come back, is it like the person is in a nightmarish dream that seems real until they come to?

    1. Dear Karen,
      thank you for writing in. Some people do report dissociation (feelings of depersonalization) during the seizure itself or in the pre or immediate postictal period.

      Nitin K Sethi, MD

  89. Hi

    I am emailing for some advice please. I had two severe vasovagal episodes. I did not faint, I went into seizures instead. I shook and thrashed around, my eyes rolled back, I went in and out of consciousness, I was pale and cold on hands and face, but not clammy. I had very bad jaw ache where I had clamped down. I have seen a consultant who informed me he felt it was vasovagal in nature but wondered if I had a low blood sugar level. I had this checked and it was normal. On both times of seizures, sugar cubes were placed into my mouth and they helped bring me round. I have just had another attack yesterday. I accidentally stabbed myself very hard on my thumb, there was a lot of blood and it would not stop. I eventually felt incredibly sick, light headed, and started to shake. I was placed on the floor by my husband. I have no recollection of what happened, but he said I thrashed slightly this time, was unconscious at times, my eyes rolled back, I was incoherent, drip white in both hands and face, He gave me a sugar cube and kept talking to me to stay awake. I eventually came round and then had to lay down for rest of day and today too to recover. Is this all normal?

  90. I am a 31 year old female and have been experiencing “fainting” spells for almost 3 years. I always have warning signs before one comes on. I start to feel really tired and often experience nausea (but no vomiting), and can’t stop yawning. Then my vision starts to go (I literally see grey spots that gradually fill my field of vision from the outside in until I pass out), and even my hearing starts to go. It’s like I can hear the blood rushing through my body and the sound muffles everything else so that eventually I can’t even hear people talking to me. At that point, I know one is coming, and I try to get myself to laying down position as that’s the only thing that helps. Sometimes I make it, and sometimes not. Fortunately, I have always been around other people when this happens, and have so far avoided injury from falling. But I have collapsed and lost consciousness and had to be laid down on the ground. People who witness the episodes say that I get a “look” for a few minutes beforehand, like I’m staring and not blinking for a few minutes. My face drains of colour. Once collapsed, witnesses have told me that my limbs are stiff and that I twitch. I’m usually only gone for a minute (or less), and though groggy, I’m usually coherent and remember what happened. If I make it to a laying down position quickly enough (before actually losing consciousness), it feels like a cool breeze over my face and head washes over me and all the symptoms start to clear up within about 10 minutes or so. Sometimes I am left with a headache, and feel more physically tired than other times.
    These episodes have occurred while standing, or even while sitting for a prolonged time (more than an hour), and don’t seem to be triggered by a change from one to the other. They seem to mostly (in fact I think always) happen in the late evening or nighttime. I used to work late and was often up past 2 am.
    When my fiance finally convinced me to go to a doctor (after threatening to take me to the ER next time it happened) he ran a full blood work up and all he found was an underactive thyroid. He also sent me for a Holter monitor (I had a spell while wearing the thing), but it didn’t show anything abnormal.
    Once I started taking synthroid for my hypothyroid condition, these “spells” went away. I assumed it was somehow related to the thyroid imbalance and that it had now been corrected with the medication. I continued to have my blood checked every 3 months, while my doctor adjusted my dosage of synthroid upward. I am now taking 125 mcgs and my levels have been stable for 9 months. However, in the past 3 months, the “fainting” spells have returned. So I went back to the doctor.
    This time he sent me for another full blood work up (nothing wrong, even thyroid was fine), a second Holter monitor (still waiting for that one — thank you socialized Canadian health care system!), an EEG (still waiting on that one too), and a Head CT (which thankfully came back clear).
    I don’t know what to do, and my doctor is frankly baffled. Subject to the EEG coming back normal (because he wants to rule out seizures), he is suggesting a “wait and see” approach, providing these episodes do not increase in frequency or severity. Meanwhile, he has banned me from driving, which I can understand, but is extremely inconvenient.
    Could this at all be related to stress?? I just finished law school last year, and when the episodes began, I was mid-way through my second year, working two jobs roughly 45 hours a week to pay for it. Now I’m articling, and probably even more stressed out than I was in law school.
    I’m also a smoker (yes, I should quit). Could that be related too? But other than that, I live a fairly healthy lifestyle, eat well, am not underweight/overweight, etc.

  91. My son fell on the ground which was a combination of dirt and small & medium rocks at school while kicking a soccer ball. He says when he fell he got right back up.He does not remember his teacher asking him to go get some of his school friends down a small slope in the ground.His friends noticed he looked a bit confused outside.He was wearing a long sleeve shirt & a cotton jacket.The temperature wasnt super hot but I`d say in the high 70`s.He walked into the school building which I`m assuming was colder than the outside at that time.The school cameras show my son looking a little dazed.He walked to the water fountain where he suddenly fell.The cameras dont show the specifics of his fall because there were lots of students going to drink water at the same time.His teacher called me.When I arrived, he wasnt responding to anyone speaking to him.I advised the school that it was ok to call EMS.My son was lethargic.He did jerk a little.He didnt turn blue.He had his legs bent with this feet flat on the ground.Once EMS arrived,they gave him oxygen & transported him to the ambulance. I explained to the EMT my son has had seizures in the past.His 1st Febrial seizure was at 2 years old.He had them when his fever would spike up.The last Febrial seizure my son exprienced was at the age of 5.My son is 8 now.He has had fever a few times between the ages of 5 and 8 however he didnt experience another seizure.The EMT suggested I contact a neurologist due to my sons history with seizures and him possibly having epilepsy. I contacted his neurologist & they couldnt see him for about 4days.The day of his fall, his pediatrics office suggested I take him to the ER to check for bleeding of the brain since my son was complaining of a headache.The ER doctor performed a ct scan & the diagnosis was my son had a concussion.The day of my sons appt. the neurologist said my son experienced VASOVAGAL SYNCOPE with convulsive event.He explained my son had low blood pressure based on these steps: my son falls & hits his head, is warm/hot from playing outside, walks into a cold building then goes into a convulsive state. The neurologist says its highly unlikely this type of event will occur again in my son. I pleaded with him to take an MRI or EEG as I was diagnosed with Epilepsy several years ago. I had seizures much sooner than my diagnosis I just never did anything about them because they werent major seizures.However, once they hindered my ability to work & drive, I was sent to a neurologist, I was unable to drive and I was unable to work anymore.I was a hard worker.I had 3 jobs & very independent so the fact that I wasnt able to drive put me into depression. I wanted confirmation my son did not have Epilepsy so I asked to please have an EEG and MRI performed on my son. His neurologist said performing these procedures was pointless due to the fact my son did not have reoccuring seizures.
    This event took place on APRIL 19th.My friends & family prayed for my son & I found peace in my heart.However,I think satan is just trying to place doubt in my head.I just cannot sleep because the more I read up on his experience, it all comes back to seizures & the word epilepsy.

  92. hi doctor…

    my son is 2.7 yr old…he is having fever since past 3 days…2 days back while sitting on the toilet seat, he said “mama, there is a powercut please light a candle mama”..then within a minute he was almost falling down when i caught him…for a second he looked at me as if he was caught doing some mischief. after that he stopped responding and was about to close his eyes,my in-law immediately sprinkled some water and he reacted. Then again he was trying to close his eyes…but we kept asking him not to sleep and took him to a doctor immediately. On the way, he didnot try to close his eyes.. then my in-law, again, to check his alertness asked him to bite her finger, which he did and smiled as well.. but he was quiet and seemed shocked all the while… at the hospital i explained everything, to which the doctor said its a case of febrile convulsions…is it really that or had he just fainted??? i m finding it hard to believe as my child didnot get stiff nor did he twitch at any point. nor did he vomit or pass urine….i know this , as i was holding him in my arms all the while… the doctor has prescribed frissium for my child…i m scared , if it will cause any side effects later…

    please kindly reply….i am really worried and concerned about the future course of action…

    thank you so much in advance..


  93. Dear Dr. Sethi,
    I am a 46-yr-old female wondering if I should consult a neurologist or simply understand my “episodes” as fainting. When I was 7 yrs old, I “fainted” at the doctors when watching an old man flinch when getting blood drawn. The dr. sent me to a neurologist then – had EEG, etc. that were nonconclusive (I was too anxious to fall asleep) – I was placed on phenobarbitol from that age through 12 yrs old — parental divorce then and no follow-up….

    As an adult, I have passed out and husband and friends tell me I convulse – the episodes are ALWAYS connected with exposure to medical treatment of myself or others – for instance, when helping an elderly woman by driving her for cataract surgery – I had an episode when I entered the recovery room and several people had eye bandages and were coming out of anesthesia — I have had episodes when I am ill and scared (stomach virus); my most recent was last week when I took my daughter to have wisdom teeth removed. I entered the recovery room and she was loopy – she put her hands in her mouth and they were covered in blood – the doctor came in and described in detail the procedure — I was able to tell my former husband I was having a problem and 30 – 60 seconds later I came to and he was holding me — I flailed and put a dent in the oral surgeons wall with the chair I was sitting in. When I came to, I was not sitting down on the chair seat but hovering above it with my muscles tightened. As I was losing consciousness and possibly during the episode, it seemed my life passed before me – joys and problems, particularly problems and I felt a sense of relief when I came to and didn’t have to deal with the “problems” that arose. I immediately asked if I spoke during the episode — husband who helped is my former husband….he said he had to hold me so I wouldn’t hurt myself and my body was thrashing around.

    My question is – is it possible that this was just a fainting episode? Or, do I have a seizure disorder?

    – this happens once every 2-3 years, depending upon the situation – always triggered by medical stuff. I’ve had 2 children and it didn’t happen during childbirth….

    Anonymous 2

  94. Hello,
    Thank you for the time taken to answer the questions!
    I was diagnosed with SVT last Xmas and admitted in hospital for a week but while in there I fainted while lying and my whole body stiffened and then after time kept having little jolts/spasms!
    I keep having moments where fade off but I am semi aware but paralysed – sometimes falling in bath and having to wait before I can move – even under water!
    Last week I was sitting down talking to someone when I leant forwards and my mind could see his desk but my eyes shut (as tho photo in mind had been taken) next I’m on the floor and whole body stiffened, head back, in recovery position being spasm into foetal position, I was semi aware in sense heard lady say “she’s fitting” and later told me they held head and put cushion under my head – others described as a seizure!

    My question is, does it sound like a seizure altho I was able to hear some altho later found out most what thought heard was actually incorrect like I dreamt the words! But also, it’s 4 days and still feel like been run over my truck physically altho starting to feel little better! It’s taken ages to recover.

    Heart/brain or ? Help 🙂

    Thank u so much – Mandy from UK xx

    1. Thank you for your question Mandy. I am unsure what plagues you. I do have a few words of advice. It may be worthwhile to attempt to capture one of your typical episodes on what we call video-telemetry (you are attached to a machine which is recording your brain waves (EEG machine), simultaneously your heart rate and rhythm is monitored and finally there is a video recording your body movements. The goal is to capture one of your typical events while hooked to the machine and then to determine whether it came from the heart or the brain. Do discuss the same with your doctor.

      Nitin K Sethi, MD

      1. Thank you for your response!
        I saw the neurologist today and was told to go back if notice any more developments but he feels it is my heart causing the symptoms rather than neurological! I forgot to mention my headaches but perhaps I should write to him just to add that although dont what him thinking I’m a pain!
        My GP not available to apps until middle of October and pulse is now 50 so nurse thinks meds need changing! It’s a shame to not have a scan or anything to rule it out but I guess have to believe all okay.

  95. Hi, I’m 15 and I have been tested for only God knows what… I have the worst memory in the world (exaggerated of corse). The first time I passed out was in Walmart sometime in elementary school with my mom and best friend. We went to the ER and saw her mom and sister there ( they got into a car wreck)
    The second was in fourth grade after I got a flu shot, my bladder released and it was horrible… I was so embarrassed and I got a concussion.
    There were others including bladder releases but I don’t remember.
    Also half of my body goes numb and tingly, and my tongue swells to where I can’t breath. It happened to me at school three times and on the bus twice. (In one semester)
    I’m tired of all of the bs and want answers. Can you help me at all?
    I’ve looked and my symptoms are those of a stroke.

    1. Hello Ashley,
      thank you for writing in to me. There are many causes why people pass out/ faint. Some are not so serious (we call them benign causes)–like one can pass out if one is dehydrated, under the weather, has been standing in the hot sun for sometime and then experiences something disturbing (like for example some people pass out when they see blood for the first time). Other causes are more concerning–for example a person may suffer a seizure and pass out (during the seizure they may sometime suffer loss of bladder control or they may bite their tongue while convulsing). Strokes usually occur in older age groups (though they can occur in the young and the causes for that is different from the cause of stroke in the elderly population). Your parents are likely aware of your episodes of fainting. If not please do bring them to your parents attention so that you can see a doctor and get the answers you seek. Stay strong. I wish you good health.

      Nitin K Sethi, MD

  96. Hello,

    I’m going to describe what happens as I’m not sure if it’s serious or just in my head. I was recently diagnosed with Non Alcoholic Liver Disease, not thinking what is happenin is a symptom of it. But I could be wrong.

    At first I noticed a couple of times that I felt strange during the day. Then those two evenings ( a few days apart) I was lying in bed and as I was dozing off, I felt like I passed out or something, my ears ( it’s hard to describe) went blank…Or deaf. I felt like I was falling and would jerk my body. Then after seconds it was gone. But they would happen 5 or so more times. Then it would be a couple of days before it happened again. I am getting them more often. I was sitting talking to a friend and had one the other night. Then last night I had one while in class. Then again in bed, but it was just one. I’m 41 years old and female. Not sure if I should go to the doctor.
    Thanks for any help.

    1. Hello Shelly,
      you describe what sounds like “hypnic jerks”. Hypnic jerks are sudden strong jerks that involve the trunk/ body and the limbs and usually occur at the time of sleep onset(when one is about to drift into sleep). Patients frequently report a sensation of falling with them. Hypnic jerks are usually benign and are more likely to occur when one is sleep deprived. My advice to you is to bring them to the attention of your primary care physician.

      Nitin K Sethi, MD

  97. After being called to my son’s school today because he had a “seizure” it sounds like syncope. In the past I have had fainting spells. I attribute them to low blood pressure, pain etc. never put too much thought in it. Now that my 10 year old is having these episodes I am concerned. He typically has them when getting out of the tub or extreme pain, but today I have no idea. He was sitting in class 10:30 am and seemed completely fine. So I have 2 questions can sinus bradycardia cause syncope and can I pass syncope to my son?

    Thanks so much,


  98. Thank you for this site. My husband recently fainted while standing- falling hard and losing bladder control. He subsequently fainted again about 40 min later while driving. This makes 4 times in the last 4.5 months.Each time he has not been doing physically demanding things. In retrospect, he’s realized that he feels pressure in his cheek or sinus area an hr or two before these events. He also noticed a metallic taste. He can work a full shift without feeling exhausted but when home often needs a nap. An ekg and echo, plus head ct did not show anything at the ER. He has an EEG and CT angiography scheduled for next week. They say his symptoms don’t quite fit regular syncope but also don’t quite fit seizure. Any thoughts? Thank you very much. We’re worried and of course he can’t drive.

  99. My 22 year son experienced Post Syncope Convulsions -much as you have described. As a follow-up, he had an EEG. The doctor reported that the EEG was abnormal and they want to start him on medications, and do an MRI to take a deeper dive as to what might have caused the syncope or seizure. Is it too soon to begin medications. This was his first incidence.

  100. dear doctor
    I was wanting to know what might be going on with my husband. he was at work back in November and I got a call thatwas at the ERthen when I got there a co-worker said thathe fell out hit his head threeon the conveyour table and hit the floor all tensed up jerking violently the hospital gave him a CT scan and it came back normal then two months later he was going to check a part and he went back to the ER for blacking out this time the people at his work said that he was disoriented and out of his mind trying to put a paper on the wall and when the asked him what he was doing he responded but when he talked it was jibberish and then all of a sudden he fell to the floor and his eyes were closed both times but he came to after a short period of time they said he was not jerking around this time he was tired and weak I am very worried about this.

  101. Dear doctor,
    Myself and my parent went for a trip to city. After few hours (4 hrs) of site seeing, we went to a hotel for lunch where the air circulation is not at the best. My mother had her food for 5 mins and started to faint. Within minutes she fainted and her tongue came out a little bit and stiffened. I tried to wake her up but in vain. I heard very rude hissing from her mouth with a little bit of tongue still out and stiff mouth. In around 5 mins she slowly came back to normal but she lost her bladder control.
    I was really afraid and this is first time I saw like this. But I know that she said she already had a couple of times before but did not lost bladder control. But the circumstances were very similar like crowded place where the oxygen supply would be less. Please advise and help us. If you can also reply your comment to my e-mail address it would be very helpful.

  102. Good Day Doctor, I received a head injury in 2007 after hitting a solid wood door very hard according to witnesses it did not knock me out but I was dazed for hours after. I hit the right temple area. I also injured my neck (3 level fusion). I started months later seemingly blacking out. The incidents continued to worsen into witnessed frequent episodic loss of consciousness, I have amnesia after with occasional incontinence. . Afterward I feel dazed with dizziness, major vision changes and constant confusion. I just fall out like the lights were turned off and later turned back on. I feel tired and in need of sleep for hours to days afterward. I never had episodes of any kind before this injury.

    I have been diagnosed with seizures. I am taking Lamictal, I am continuing to have seizures 4 to 6 times a month. After a multitude of test, finally an MRI and MRA showed that my right mca artery is 100% occluded. Please give me your best outside looking in opinion.

    1. I should also say that my continued concern is what if the collateral flow is not enough and the lack of blood flow is causing the seizures? I realize that you can only speculate as you have not seen me, nor my test results. My bouts with amnesia and the fact that keep injuring myself hitting things are very troubling.

  103. Hello

    I have been diagnosed with convulsive syncope. Originally I was diagnosed with epilepsy but in the last two years my current neurologist has changed the diagnosis to convulsive syncope. I’m not on medication and live a relatively quiet life style at 67 years. In 10 years I have had four episodes. All the tests have been done with no positive trigger being evident. After the first episode the second occurred 2 years later the third 7 years later and the fourth 1 year later. The last two episodes occurred while vacationing in Mexico.
    I can sense the attack coming on and have been told to lay down immediately. I usually get about a 4 minute warning. I go into a grand mall seizure and loose consciousness for about 5 minutes. I don’t loose bladder control and have bitten my tongue slightly the last two attacks. Laying down has only been an alternative for my last attack which occurred in February 2014 unfortunately I didn’t stay down long enough to abort the attack. During the attack I was able to tell my rescuers where I was staying and they contacted my wife. Within minutes and ambulance arrived which I don’t remember and I was hospitalized overnight in San Jose del Cabo, Mexico.

    I’m only providing this as information and do feel fortunate that I have only had 4 attacks in the last 10 years. With the new diagnosis of syncope (2 years) and making the effort to lay down regardless of where I might be I believe I can handle the situation better in the future.

  104. Hi, after three years of getting more or less the same answers from a handful of neurologists and a few cardiologists, I stumbled across your information and would really love your input. I understand you don’t diagnose over the internet but your knowledge on this subject is profuse. Out of the blue three years ago I was on a treadmill working out when I started feeling off. I’d never experienced the feeling. I stood on the rails and was trying to step off when I lost consciousness. The lady next to me was trying to prop me up, and noticed convulsions (slight) and called 911. Every episode since:

    – I always feel them coming. I don’t know how to describe it, but I’m fully able to talk coherently during the period prior and I remember that conversation after I “wake up”.
    – If I lay down immediately I can often prevent the entire event from proceeding. Not always, but often, if I lay down with my feet up it passes quickly. My most recent neurologist does not believe that a grand mal seizure can be stopped once it’s begun, and therefore believes it’s syncope.
    – I’ve had these happen both standing and sitting but never laying down or sleeping.
    – I don’t fall to the ground. I have never been injured falling. Usually, I look like I’m struggling to keep my balance (stepping backwards and using my arms to try for balance).
    – I’ve never bitten my tongue.
    – I’ve never wet myself.
    – Typical length of convulsion is 15 seconds. I regain consciousness immediately after these convulsions stop.
    – There is a period of slight confusion following most episodes. These can last seconds or a few minutes.
    – I’m tired after, but not to the point I need to sleep.
    – One thing that others have noted is that I usually turn my head to the side before the convulsions start.
    – On occasion my movements have been so subtle you can’t see them, you have to touch me to feel them (although they’re usually more pronounced than this). My mother is able to cradle me while they’re happening, but she usually pulls my ankles up in the air because it helps revive me faster.
    -They did perform a tilt table test. I was feeling pretty good, but then they gave me nitroglycerin and out I went. I’m not sure if that skews the results.
    – My cardiologist has me on Midodrine for low blood pressure. It gives me a headache and makes my scalp itch but I do believe it increases the “warning time” before an event.

    I’m desperate for some conclusions and/or advice. Without putting you on the spot I’d love to hear what your gut feeling is.


  105. So I was sitting down watching some TV and my husband asked for a hug so I stood up to give him one. As I put my arms around him, I started getting light headed and my vision started becoming blurry so I told my husband that I was light headed. Next thing I knew, I was on the floor with a chewed up tongue, pretty shaken, some tears, and a high pulse. My husband said that had he not caught me, I would have hit my head on the wall next to me. It sounds like it could have been either of the above issues, but I’m not certain. I also wasn’t sure how serious it was so I didn’t let my husband rush me to the hospital, but should I have?

  106. Hi Doctor

    I am 37 years old. I am having this jerking problem for past 9 months
    it only happen in the morning. I felt jerking and the passed out .I bite my tongue few times
    and lose of bladder control too. I am confused that if it is a seizure why it happen only in the morning. Please advise.

    Thanks and Regards

  107. My son is 12 year old recently ruled out with vasovagal syncope. everytime he faints his legs pain a lot. He was taken to neurologist who suggested him eeg, ct scan, Hutt test, Holter test, 2D Echo, Doppler and blood test with diabetic profile everything was normal except hutt test was positive he was rule out as vasovagal syncope. But when my son fainted again in school with 5 minutes of standing, i took him to a piedatrician, as he was suffering from cold and cough with slight fever. His piediatrican prescribed some antibiotics and also we told him the whole story he prescribed him valporin 200 mg twice a day i doubt that neurologist suggested no medications as he said for vasovagal syncope we do not have a regular medications. please help me as i am confused at this situation, plz answer my question

  108. Dear Dr. Sethi,

    I’m not sure what happened to my wife, if it was syncope or a seizure.

    My elderly wife was lying in bed (we have an adjustable bed and her torso was slightly elevated, perhaps about 20 degrees). She started coughing and then suddenly the coughing transformed into something else. Her whole body started shaking violently, her tongue was hanging out of her mouth at an angle, her lips were clenched down around her tongue. I grabbed her shaking hand and she didn’t appear to notice I was even there. Her eyes were rolled back but somewhat open. This episode lasted perhaps 40 seconds, after which her eyes rolled back down to the normal position. She had a blank stare but seemed “awake” and “recovered” at this point, without convulsions. After a minute or two she was able to speak either yes or no to the following questions: I asked her if she was in pain and she said no. I asked if she remembered the last several minutes of her life and she said no. I asked if her mother’s name was Shelly and she promptly answered “yes”. She couldn’t remember absolutely anything of what transpired, but seemed to recover fairly quickly.

    Is this a seizure or syncope? It did start with a couple of coughs, but right after that her mouth clenched up. Her face also became very red in color as if she couldn’t breath. I should mention she also has mild emphysema.
    If she couldn’t breathe, wouldn’t she have opened her mouth?

    Please help, I want to take her to a doctor but she says she feels fine and doesn’t see the need!

  109. Is this a type of blackout or a type of seizure:,please explain everything regarding what it is, the cause, why is the description leaning to one and not the other, diagnostic tests to confirm and also treatment:

    Wife says husband have 2 types of blackouts, one where he’s completely out and one where he’s not.
    She only ever saw the 2nd type as he called out to her.
    She says he wasn’t ‘out of it’, he was just calm and breathing and closed his eyes. She held his hand but it was limp. He was sitting upright and his head fell backwards and he opened his eyes. Afterwards he’s just tired.

  110. I have a question i woke up in th e morning and when i standed up i got dizzy and my head was spiinspinning around the room and theainian i started fainting to the floor and i had to ly floor because i got nausated i could not walk and i got back up and i broke out in a hot sweat. im not medication that makes me dizzy could that be a problem with my meds or is it that i got up to soon

  111. Dr Sethi
    A very easy to read and easy to understand explanation in your article .Thanks for the same!

    -My mother has had 3 episodes in the last year..
    Everytime she has gone to the toliet . Twice she fainted and fell from the pot itself, both times cutting her lip. The 3rd time ( a week ago) she was coming out of the bathroom and fell.
    – She has no recall of fainting or anything specific before that. At least two times she has complained of stomach pain/cramps when she went to the toliet. All 3 times this has happened in the night/early morning.
    – In the latest episode , we observed her. She was like in a shock, eyes wide open and not responidng. As she started coming around, she started speaking rapidly and a bit of incoherent/gibberish. After that she would respond logically , but mainly in English (otherwise normal conversation at home is in Hindi)
    – Our estimate is that her fainiting episode lasts 5-10 mins every time
    – Every time rushed her to ER- BP, Sugar, Electrolystes, ECG, CT were not alarming. Pulse was 56/57. Subsequent tests ( Echo, Halter, EEG) also inconclusive
    – Neuro opinions have differed- one suspects seizure other feels its cardia. Cardio opinion indicates Vasovagal and advises that avoid getting out of bed suddenly, any sudden expsoure to cold floor etc. Has prescribed Vertin 16 mg twice a day.

    We are fairly confused. Any advise from you would be appreciated.


  112. Doc I need help I just had a syncope it was my first time I was laying on my bed facing a laptop screen then I decided to stand up and go pee as I was peeing I started feeling dizzy with a blurry vision (actually this has been happening to me frequently but only stops at the blurred vision then I come back to normal) this time I found myself on the ground

  113. My 32 yr old daughter collapsed in our arms two weeks ago inthe doctor’s office and arms shook for 10 minutes eyes rolled back and could not talke. She was admitted they say vasovagal without doing test. She was diagnosed with MRSA in blood caused by power port. They removed on Monday, last week. Wed she had a power pic line put in and was still on IV daptomycin discharged Friday and had to be back everyday to outpatient for infused daptomycin for two weeks. We went Saturday for two hours for first treatment. came home and three hours later she feels dizzy, we help her to floor. She shook for 45 minutes and could not open eyes, They rolled back and could not talk for 75 minutes. She is in ICU with Sepsis. What could be going on. I havent read that syncope makes you not talk. were these seizures or not. Does MRSA and Sepsis have anything to do with it. Too much. She has a lot of medical conditions, steroid depended for 17 yr pancreatitic, cellulitis, gastroparesis sinusitis. Has vena cava filter since DVTs and PEs. Help.

  114. Hi

    I wonder if you have come across a case like my daughter. She us 12 and since June of this year has fainted very regularly. They diagnosed her with vasovagal faints and sometimes faints up to three times a day. However she has moved onto long duration faints. She has been taken to hospital for a 30 minute faint, a 15 minute faint and just yesterday a 56 minute faint. The Dr feel that it isn’t epilepsy and all her blood work and urine tests have come back normal. We are going to see a neurologist shortly but jyst wondered if you had ever seen a similar case as its very alarming to gave your child unconscious for an hour. Thanks

  115. Dear DR.Sethi
    I have been suffering from what I believe to be seizures for two years now.
    I get an aura a very nasty taste in my mouth and a nauseating feeling in my stomach and then I’m out from any where between 20 second to 30 minutes depending on how bad they are. My husband says they can be quick and over and very violent and I flop around like a fish and bite my tongue and bleed every where. I have only lost my bladder control 5 times in all the seizures I’ve had which are countless. And most of my seizures are nocturnal over the last 2 years. I’ve been having this aura feeling since I was a kid I am now 26yrs old uncalled it da javu. It always bothered me badly. As a kid it was always during the day and several times a day. For some reason after giving birth it went very bad started happening in my sleep I saw a neurologist he says they are seizures but we can’t catch them on EEG only thing we’ve got is “sleep disturbance” no siezures so anytime I go to the ER for care when I desperately need it they tell me I’m fone and send me home with non epilectic DX. Because it’s never been caught on EEG but yet I’m still on AED’s. I am started to get them more now in the day time and at night and I don’t know what to do to make sure I get the care I need in an emergency I am loosing this battle I’m almost to the point of needing a wheel chair because I’m getting so weak. And I can’t even explain why I am so weak and why it’s so hard to walk and do daily chores. Can you explain?

  116. Hours prior, I had some blurry vision that self-resolved. After standing for approximately 10 minutes, I started feeling lightheaded and dizzy, and was attempting to leave the room I was in. I didn’t make it. The person I was conversing with said I stopped responding, began to sway – he helped me to the ground and called for help. On-lookers (ped er nurses) stated that when they saw me on the ground, my eyes were open and I was looking up and to the right, my legs were straight and stiff with toes pointing to the right, left arm bent towards chest with fist clenched tight, jaw clenched, and I was pale. This lasted 15 seconds and as soon as it was over and I came to, I was drenched in sweat. Per the nurses, I was not sweating during. My confusion after only lasted a few seconds. No loss of bladder control occured. The ER physicians say syncope but still don’t know what to make of the muscle rigidity. My pcp also says syncope. I don’t know what to think when everyone that saw me (ER nurses) say I did have a syncopal episode that was followed by a seizure. Comments.

  117. Hello doctor , a couple of days back i.e.26th Dec 2014,after my lunch around 2pm , I just started to sleep.My wife is outside of room ,doing some work ,heard a snouring sound that is quite bigger and abnormal. She found me in an unconscious , nodding my head, moving eyes slowy.The froth came our is in color with the curry I had i.e. prawns curry. After 3 mins I am conscious , but completely confused , I did not knew that something happened , and they took to me to a doctor , there they told me. I am completely shocked. Because I suffered with this in 2006, 2007 , and took medicines for almost 2012. As I have not noticed any occurrence, i stopped medication. After that this is the 1st incident. Please suggest which kind of seizures this is. Out of all noticed occurrences, 2 times I got in sleep earlier, 2 times while taking food. This is another one in sleep.
    One common thing is I am clueless , that I am going to get a convulstion also , I do not know what has happened after this. Earlier all my EEG, MRI shown normal. Please suggest , what kind of this seizure is and what I can do? Thank you so much for reading this big passage.

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