In general, ascertain the details of the events prior, during and following an attack.

Prior to Attack

Any warning signs?

• Brief warning (aura) of epilepsy, for example strange smell or taste or feeling, for example rising epigastric sensation.
  
• Prodromal symptoms preceding syncope, for example light-headedness, visual dimming and feeling sweaty.
  
• Any identifiable triggers/provoking factors? [(Emotional response (seeing blood), hyperventilation, prolonged standing and hot surroundings in vasovagal syncope; immediately post voiding urine in micturition syncope; standing up in postural hypotension; or alcoholic binge or abrupt withdrawal and head injury in seizure).]

During the Attack

• Posture, for example lying down or standing? (Vasovagal syncope is very unusual if patient is lying down).
  
• Patient awake or asleep during event? (Seizures often arise from sleep).
  
• Any loss of consciousness? (Both seizures and syncope can cause this).
  
• Duration of loss of consciousness? (Seconds in syncope versus minutes in seizures).
  
• Still while unconscious (more suggestive of syncope) or stiffness followed by jerking of limbs? (Tonic–clonic seizures)
  
• Involuntarily passing of urine or faeces? (Considered to be a seizure marker but can occur in syncope).
  
• Biting of tongue? (Rare in syncope; commoner in tonic–clonic seizures, where often the side of the tongue is damaged).
  
• Any other associated symptoms like palpitations or breathlessness? (Arrhythmias in cardiac syncope)

After the Attack

• Period of confusion, amnesia or drowsiness after attack? [Rapid recovery in syncope without prolonged confusion or amnesia versus prolonged drowsiness and confusion in epileptic seizures (postictal period)]