Watch that bite: syncope versus seizure

The conclusion was that repeated tongue biting in the context of seizures had resulted in formation of accessory tissue on the left lateral aspect of her tongue. The presence of lateral tongue biting is strongly suggestive of a generalised tonic-clonic seizure, initially reported in 1995 to have a specificity of 99%.1 This was supported by a more recent systematic review in 2012 confirming lateral tongue biting to have a specificity of 100% when differentiating seizures from non-epileptic seizures, but a sensitivity of only 22%. [...]lateral tongue biting is a good "rule in" sign; however, the absence of this sign cannot be used to "rule out" seizures.2 One can also see tongue biting in syncope or non-epileptic seizures, but this is more often at the tip of the tongue Л3 Although this case represents an exaggerated example of a relatively common clinical sign, careful examination of the tongue should always be performed in instances of unexplained loss of consciousness. CORRESPONDING AUTHOR Tony Zhang: Department of Neurology, Auckland City Hospital, 2 Park Road Grafton Auckland 1023, New Zealand.