5 ways to differentiate between convulsive syncope and seizures

Syncope, also known as fainting, simply occurs when there is an insufficient supply of blood flow and oxygen to the brain. Convulsive syncope occurs when ‘fainting’ is paired with movement (or “motor activity”). 

On the other hand, a seizure is caused by a sudden, electrical disruption in the brain. It is commonly diagnosed as epilepsy when it becomes more frequent and needs to be managed by medications

To the untrained eye, both a seizure and a syncopal event could appear similar as they could be recognized by someone falling to the ground or slumping on a chair while seated. This similarity in outward symptoms poses a problem to even well-trained physicians, especially when such an event is the patient’s first experience.

Studies have shown that although an estimated 1% of the population has epilepsy, about 25% of those patients diagnosed show no clinical evidence of epilepsy. Other research carried out by various experts have reported misdiagnosis rates ranging from 4.6% to 30%. Despite the wide range of these rates, it still holds significance because the number one goal is to preserve life and that goal would be misguided if the wrong patients were being managed with anti-epileptic medications (AEDs).

Although seizures and syncope can both be mistaken for a number of issues that could be associated with psychological and sleep disorders, for the purpose of this article we will be focusing on the more common differential diagnoses ‘convulsive syncope vs seizure’.

Here are 4 easy ways to differentiate between the two…

5 common reasons for sudden facial asymmetry

Facial asymmetry refers to one-sided physical or aesthetic differences between the left and right side of the face. If it appears on both sides, it will be symmetric. Acute onset facial asymmetry usually refers to an injury or an impingement to the facial nerve, which is the nerve that is responsible for most of the functions in the face, causing facial weakness or paralysis over a relatively short amount of time.Although such an injury could occur as a result facial/head injury caused by external trauma, the main focus will be on those causes that are related to the muscles and nerves of the face.  

Bell’s Palsy

Bell’s palsy is the leading cause of facial asymmetry the United States with up to 40,000 cases per year and is responsible for 72% of facial paralysis. It is typically characterized by weakness to one side of the face and although causes of Bell’s palsy are typically unknown, there is growing evidence that most cases likely involve the reactivation of herpes simplex virus.

Stroke

Strokes can present as one-sided facial droop and is a probable cause for facial asymmetry over a relatively short time. The clinical presentation of this is quite similar to the bell’s palsy and it could be misdiagnosed as bell’s palsy due to their striking resemblance.

Lyme disease

Lyme disease is commonly caused by bites from deer ticks which are commonly found in north-eastern and north-central regions of the United States. Facial nerve injury is a common symptom of Lyme disease occurring in about 50% of American cases. Facial paralysis caused by Lyme could be asymmetric or symmetric.

Neurosarcoidosis

Sarcoidosis is an autoimmune disease that can affect all your organs, for example, brain, liver, lungs and kidney. Sarcoidosis patients who develop neurological symptoms are said to have neurosarcoidosis, and facial nerve injuries which cause facial weakness are a common symptom. In the case of neurosarcoidosis, facial abnormalities can be symmetric or asymmetric.

Tumor

Intracranial tumors can physically push against the facial nerve which can cause one-sided facial weakness leading to facial asymmetry. Facial nerve injuries caused by tumors usually progress slowly overtime but acute onset facial weakness is also possible.

4 differences between bulging and herniated discs

Back pain can be debilitating! It can cause issues with most daily activities including standing, walking, bending and changing positions. Along with the flu, it is one of the most common and believable reasons for taking a sick day in the U.S. It is also the leading cause of disability worldwide with almost 80% of people experiencing it at least once in their lives.

Causes of acute back pain mainly include strains and pulled muscles in the lower back which typically arise from improper form while lifting heavy loads. Other causes of back pain include herniated discs and bulging discs. This may be slightly more unfavorable to the integrity of the spine because herniated or bulging discs increase the likelihood of a compressed nerve root in the spine which can lead to more serious issues. The spine is made of vertebrae which are separated by fibrous discs with a gel-like center which serve to allow movement and stability of the spine. A disc bulge or herniation simply occurs when the gel-like substance within the discs protrude out of its walls due to injury or gradual degeneration overtime.

In reality, a disc herniation refers to the latter stages of a bulging disc where the bulge is so far out of position that it compresses a nerve root causing pain and abnormal sensations to corresponding limbs.

Herniated discs and bulging discs are usually mistaken for one another. Here are 3 ways to differentiate between the two.

5 main things to avoid if you are at risk of seizures

A seizure is a sudden, electrical disruption in the brain. Seizures are controlled with medications but when they are recurrent or difficult to control, one could be diagnosed with epilepsy or seizure disorder. Epilepsy is quite common, and it affects nearly 3.5 million people in the United States, including almost half a million children. It can be characterized by episodes of uncontrolled movements, convulsions, loss of consciousness or changes in behavior.

These episodes could last for a few minutes at a time and it is important to avoid certain environments which could complicate them.

DRIVING

Similar to popular notions such as “Do not drink and drive”, patients who are at risk for seizures should avoid driving at all costs. The few minutes of disruption caused by a seizure could be fatal to yourself and other drivers when behind the wheel. Texas regulations state that drivers who are at risk of seizures should be free of seizures for 3 consecutive months before going back on the road. Driving includes forklifts, golf carts and any other off-road vehicles.

UNSUPERVISED OUTDOOR/AQUATIC ACTIVITIES

It is very important to stay as active as you can when you can. But, if you are at risk of seizures it is even more important to have a chaperone who is skilled and alert enough to assist you in the event of a seizure. Activities like swimming, hiking, horseback riding, kayaking, cycling etc, require a certain level of coordination. In the event that your coordination is lost during those few minutes of inattentiveness, you would need someone around to either anticipate dangers before they occur or help out afterwards. Drowning and outdoor accidents are leading causes of death in seizure patients.

HIGH PLATFORMS/HEIGHTS

Being diagnosed with a seizure disorder isn’t exactly the best time to act out your Spiderman fantasies. Platforms such as cliffs, ladders or rooftops should be simply avoided to prevent seizure- induced falls. If your job requires high platforms, communicate with your supervisors to request alternative assignments.

HANDLING FIRE, CHEMICALS & ELECTRICAL TOOLS

If it is dangerous to handle it is even more of a danger when seizures are involved. Hazardous materials, even when enclosed, are dangerous and need to be handled with utmost care. People who are seizure risks stand the risk of convulsions which can expose themselves and others to those dangerous materials in their possession. If your job requires you to handle such substances, communicate with your supervisors to request alternative assignments.

OVERHEAD HEAVY LIFTING

When exercising, you are more than welcome to use weights you are comfortable with to train your muscles. However, those who are seizure risks should avoid lifting heavy loads over their heads to prevent any accidents. This is because any loss of sudden loss of coordination while performing such exercises could cause the weights to fall and cause serious injury or trauma.

3 common signs of dilantin toxicity

Dilantin, also known as phenytoin, is a very popular medication used by physicians for seizure management. It has gained its popularity overtime because it is one of the most thoroughly studied and affordable medications available to the general public.

For those diagnosed with epilepsy, it is important to work with a doctor to achieve the most effective Dilantin dosage for seizure control. This is done by regularly checking Dilantin levels in the blood and reporting any unusual side effects to your physician so that any signs of overdose are caught immediately and corrected. Blood levels of Dilantin (and other medications) are also a very good way to tell your doctor if you are taking your medications as directed.

The average starting dose of Dilantin tablets in adults is 100mg, three times a day, by mouth (300mg/day). It takes an average of 22 hours for half of that dosage to be cleared from the body. Depending on weight, lifestyle and activity, it could take as little at 7 hours or as high as 42 hours. Because this medication is processed at different rates from person to person, it is important to be aware of the 3 most common signs of that could indicate toxicity even though your blood levels may come back normal from the labs.

#1 ATAXIA

Ataxia comes from the Greek word “taxis” which means order and the prefix “a” usually indicates the opposite of the comes after it. Hence, ataxia is simply a lack of coordination which can lead to difficulty walking, speaking an using hands.

#2 NYSTAGMUS

Nystagmus can be described as involuntary eye movement which can be present in one eye or both eyes. It can cause blurred vision, imbalance and dizziness.

#3 DROWSINESS

Drowsiness is a feeling of unusual sleepiness or fatigue which can occur as a result of Dilantin toxicity.