Convulsive syncope is a common cause of misdiagnosis in patients who present with a transient loss of consciousness. This misdiagnosis contributes significantly to the numbers of patients with a questionable diagnosis of epilepsy, and to those with apparently drug-resistant epilepsy. The most important step to an accurate diagnosis is a fastidious history. Inducing syncope with tilt table testing and documenting heart rate changes during events with implantable loop recorders have proved to be useful. These suggest the need for closer and ongoing collaboration among neurologists and cardiologists to provide optimal care for patients with the diagnostic dilemma of syncope or epileptic seizures.