Choice A. Although abnormal convulsive movements of the extremities are common with epileptic seizure, they can also occur with syncope (due to transient cerebral hypoperfusion and hypoxia). The timing of convulsive movements (ie, before or after LOC) can help distinguish seizure from syncope, but the presence of the movements alone is not helpful.
Explanation
Educational objective: Epileptic seizure can present similarly to a number of other conditions and can be especially difficult to differentiate from syncope. Tongue biting, especially of the lateral tongue, is highly specific for epileptic seizure and can be helpful in confirming the diagnosis.
Choice C. Episodic nature of symptoms is typical of syncope and most other diagnoses in the differential for epileptic seizure. It is not usually helpful in confirming the diagnosis.
Choice D. Patient position at onset of symptoms is relatively unhelpful in differentiating seizure from syncope. Although vasovagal syncope occurs in a standing position, cardiogenic syncope (eg, due to ventricular tachycardia) can, like seizure, occur in any position.
Choice E. A postictal period of ongoing confusion or other symptoms (eg, extremity weakness) is typical following epileptic seizure, and the duration of the period is highly variable (ranging from seconds to hours or even days). A long postictal period can be helpful in differentiating seizure from syncope, but this patient's return to baseline in 2 minutes is similar to a typical episode of syncope and is not significantly helpful.
