As a cause of transient loss of consciousness, syncope is important in the differential diagnosis of epileptic seizures. This chapter examines the classification, diagnosis, and treatment of syncope in the clinical context of an epilepsy unit based in a neurological department of a university hospital. The frequency of syncope varies between 7% and 25% in different populations of healthy persons and patients. However, syncope may account for less than 3%, possibly 1–2%, of visits to the emergency department. With regard to prognosis, it is mandatory to establish whether an underlying cardiac cause is present and requires treatment. A good medical history may be decisive for a correct diagnosis, and routine laboratory tests, electrocardiography (ECG) including long-term ECG monitoring, blood pressure monitoring, carotid sinus massage, echocardiography, tilt-table testing, and video-EEG monitoring may be warranted, especially in patients with serious symptoms including falls with physical injury, or where occupational hazards are present. Treatment options are discussed briefly, as are two cases, reflecting upon the complexity of differentiating syncope and epileptic seizures.