Postictal sleep: syncope or seizure?

A 6-year-old boy presented with prolonged periods of unconsciousness (>60 min) following nausea and dizziness while standing. The application of EEG electrodes provoked a similar episode. These apparently long periods of unconsciousness could be explained by sleep. In view of the triggers (pain, distress, and prolonged standing), the prodromal features, and the transient sinus bradycardia during the EEG examination a diagnosis of vasovagal syncope was made. Sleep is an alternative explanation for delayed recovery after syncope in young children. Prompt recognition might avoid unnecessary investigations, distress, and an incorrect diagnosis.