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The second most common neurologic emergency is transient loss of consciousness (TLOC). Three conditions account for 90% of presentations: epilepsy, psychogenic nonepileptic seizures (PNES), and syncope. Several eye-witness observations are of great help in differentiating these conditions. Head turning, frothing at the mouth, long duration of unconsciousness, and confusion are strongly predictive of epilepsy; pallor makes syncope more likely than epilepsy; and in PNES, complex movements such as writhing, flailing, and whole-body thrashing are more common.
The objective of this study was to explore how additional information from event witnesses could improve the differentiation among epilepsy, syncope, and PNES. Patients with transient loss …