Cardiac arrhythmias may cause syncopal attacks masquerading as epilepsy. Conversely, epileptic seizures can induce tachyarrhythmias or bradyarrhythmias (and rarely, as a result, fainting). Differentiating between these two possibilities may prove difficult without concomitant ECG and EEG recording.

A 39 year old male lorry driver, without cardiac and neurological disorders and not taking medication, was admitted to a coronary care unit after a cluster of episodes of loss of consciousness preceded by epigastric warm sensation and a bitter taste in the mouth, and followed by pallor, sweating, muscle jerking, and rigidity with arrest of the pulse. The episodes occurred both in orthostatism and clinostatism. Clinical investigation, laboratory tests, clinostatic and orthostatic blood pressures, echocardiography, and ECG at rest, during exercise, and during carotid sinus massage were normal.

He experienced another attack while on continuous ECG monitoring. A nurse stated that the patient complained, while standing, of epigastric discomfort, followed by a fleeting phase of unresponsiveness and purposeless arm and mouth movements. A few seconds later he fell and showed a generalised tonic convulsion. The pulse, apparently normal during the initial phase of the episode, abruptly ceased when the patient collapsed. The ECG recording (fig 1) showed a progressive decrease of heart rate, culminating in a sinus arrest of 9.5 seconds, preceding the fall. Another four episodes of sinus arrest of 4-5 …