Epilepsy and Syncopen (fainting attacks)

Patients with epilepsy have always been confronted with many prejudices. In the Middle Ages, for example, it was assumed that these patients were possessed by an evil spirit and they were excluded from normal social life. Skull findings from this time show holes in the skullcap caused by surgical interventions, through which the evil spirit was supposed to escape. Just the sequence of a large generalized seizure with twitching all over the body, loss of consciousness and tonic spasms still frightens many today who are unprepared for a seizure.

Epileptic seizures are basically caused by uncontrolled electrical discharges of nerve cells in the brain. Whether these discharges then lead to unconsciousness, impaired consciousness or no mental impairment, basically allows a differentiation into so-called generalized (with unconsciousness) and focal (with a disturbance of consciousness or even without any loss of consciousness). The correct classification into these different groups and assessment of the disorder of consciousness leads to considerable consequences in everyday life as to whether, for example, a patient with epilepsy roadworthy is or is not. Patients with epileptic seizures that can occur unexpectedly at any time and lead to a disturbance of consciousness are generally unfit to drive if it cannot be assumed with certainty that they will become seizure-free, for example through drug treatment. Patients with simple focal seizures, such as the rhythmic twitching of a hand without a disturbance of consciousness, may be unfit to drive even though they have been diagnosed with epilepsy. This distinction and the assessment for Fitness to drive can only be made by a neurologist who has thoroughly examined the patient.

The causes of epilepsy in are as the different forms very different, there are innate forms, which often occur in childhood and can be genetically inherited, but also acquired Epilepsy caused by circulatory disorders, brain tumors, inflammation of the brain or alcohol/medications.

The diagnosis of epilepsy is made after a careful description of the seizure process using the Electroencephalogram (EEG) which records the electrical activity of the brain. During an epileptic seizure, typical electrical discharges occur similar to a "thunderstorm". However, these discharge patterns do not have to be visible in a seizure-free phase, which is why the diagnosis is sometimes not easy. In such a case, an EEG with video recordings over 24 hours is used to record a longer period of time or, for example, seizures during sleep or out of sleep/ in the phase of falling asleep.

For seizures that do not occur until later in life , a Magnetic resonance imaging (MRI)  to identify the cause, since these seizures are often accompanied by morphological (structural) changes in the brain (for example, stroke, brain tumors, etc.).

Not for every Fainting (Syncope), even if it is accompanied by twitching of the arms and legs, it is an epileptic seizure. Circulatory fainting can also look very similar, the distinction is sometimes a challenge for the neurologist.

Further information

German Society for Epileptology e.V.

German Epilpsy Association e.V. Self-help groups

Epilepsy online