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Transient loss of consciousness through the eyes of a witness

From the Department of Neurology and Clinical Neurophysiology (R.D.T., J.G.v.D.) and Department of Neuropsychology (H.A.M.M.), Leiden University Medical Centre; Department of Experimental Psychology (W.A.W.), Leiden University; and Department of Internal Medicine (W.W.), Academic Medical Centre, Amsterdam, The Netherlands.

Address correspondence and reprint requests to Dr. Roland D. Thijs, Department of Neurology and Clinical Neurophysiology, Leiden University Medical Centre, Postal Zone J3-R, PO Box 9600, 2300 RC Leiden, The Netherlands r.d.thijs{at}lumc.nl.

Objective: To assess the accuracy of eyewitness observations of transient loss of consciousness.

Methods: Two sequential cohorts of psychology students unexpectedly viewed videos of a generalized tonic–clonic seizure (n = 125) and of reflex syncope (n = 104) during a lecture on an unrelated subject. Directly afterward, the students filled in a multiple-choice questionnaire regarding muscle tone, twitches, head deviation, eye closure, gaze deviation, drooling, and facial color. The consensus of experienced neurologists served as a gold standard. Even though not all items could be ascertained from the videos, the full range of questions was included to simulate clinical practice.

Results: Of all responses to the observable items on the syncope video (flaccid limbs, twitches of one shoulder, head deviation), 44% were correct, 28% erroneous, and 29% had "I do not know" responses. The observable items on the epilepsy video (stiff limbs, twitches of all limbs, normal facial color, drooling, no head deviation) yielded 60% correct responses, 18% erroneous responses, and 22% "I do not know" responses. Regarding features that were not visible on the videos, 77% of the responses were accurate ("I do not know"), whereas 23% erroneously provided an observation. Of all items observable on both videos, muscle tone was the most accurately recalled item.

Conclusions: An eyewitness account of a single episode of transient loss of consciousness (TLOC) should be interpreted with caution because salient features are frequently overlooked or inaccurately recalled. However, the accuracy of the eyewitness observations of TLOC differs per item; muscle tone was reported with high accuracy.

Abbreviations: TLOC = transient loss of consciousness.

Supplemental data at www.neurology.org

No external funding.

Disclosure: The authors report no disclosures.

Received February 4, 2008. Accepted in final form August 13, 2008.

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				Beware of Eyewitness Accounts of Syncope or Seizures Journal Watch (General), December 11, 2008; 2008(1211): 2 - 2. [Full Text]