Syncope is a self-limited loss of consciousness produced by cerebral hypoperfusion/hypoxia. The objective of this study was to categorize the etiology and determine the frequency of concurrent epilepsy and whether laboratory testing is diagnostically useful. This was an institutional review board-approved retrospective chart review. Data were analyzed using descriptive statistics. There were 141 subjects (90 girls [63.8%]; mean age, 12.01 years). Of the syncope referrals, 86 of 123 (69.9%) had simple syncope, 35 of 123 (28.4%) had syncopal convulsions, and 2 of 123 (1.6%) had epilepsy alone. An electroencephalogram was performed in 64.7% (91/141) of the subjects but was diagnostic in 1 of 91 (1.4%) for epilepsy. Magnetic resonance imaging and/or computed tomography scans, electrocardiograms/Holter monitoring/stress testing, and blood tests were primarily normal or nondiagnostic, with 6 of 238 (2.5%) total tests contributing to the diagnosis. Primary neurocardiogenic syncope was identified in 78% (111/141) of all subjects (82% boys, 75% girls). Thirty-eight percent had syncopal convulsions, and 2.8% (4/141) had concurrent epilepsy. A detailed medical history was the most useful diagnostic tool.