Non-Epileptic vs Epileptic Seizures

Q: Patient is 29 year old female with history of bipolar disorder, PTSD and borderline personality disorder. Patient is brought to emergency room for recent episode of seizure at home. Psychiatry is consulted to rule out non-epileptic seizures. 
Which of the following clinical symptom is COMMON in Epileptic Seizures but RARE in Non-Epileptic Seizures?



 

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(1) ONSET:

  • Gradual Onset: common in non-epileptic seizures but rare in epileptic seizures.

 


(2) MOTOR ACTIVITY:

  • Undulating motor activitycommon in non-epileptic seizures but very rare in epileptic seizures.
  • Asynchronous limb movements: common in non-epileptic seizures but rare in epileptic seizures.
  • Purposeful movements: Occasionally seen in non-epileptic seizures but very rare in epileptic seizures.
  • Side-to-side head shaking: common in non-epileptic seizures but rare in epileptic seizures.

 


(3) TONGUE BITING:

    • Tongue biting on tip: Occasionally seen in non-epileptic seizures but rare in epileptic seizures.

 

  • Tongue biting on sidescommon in epileptic seizures but rare in non-epileptic seizures.

 


(4) EYELIDS:

  • Closed eyelids: very common in non-epileptic seizures but rare in epileptic seizures.
  • Resistance to eyelid opening: common in non-epileptic seizures but very rare in epileptic seizures.
  • Pupillary light reflex: Commonly absent in epileptic seizures and usually retained in non-epileptic seizures.
 

(5) ICTAL PHASE:

  • Convulsion > 2 minutes: common in non-epileptic seizures but very rare in epileptic seizures.
  • Ictal crying: occasional in non-epileptic seizures but very rare in epileptic seizures.
  • Closed mouth in ‘‘tonic phase’’: occasional in non-epileptic seizures but very rare in epileptic seizures.
  • Vocalisation during ‘‘tonic–clonic’’ phase: occasional in non-epileptic seizures but very rare in epileptic seizures.
  • Reactivity during ‘‘unconsciousness’’: occasional in non-epileptic seizures but very rare in epileptic seizures.
  • Lack of cyanosis: common in non-epileptic seizures but rare in epileptic seizures.

 


(6) POST ICTAL PHASE:

  • Rapid postictal reorientation: common in non-epileptic seizures but rare in epileptic seizures.

 


Source:

  1. Reuber M, Elger CE. Psychogenic nonepileptic seizures: a review and update. Epilepsy and Behaviour 2003;4:205–16.
  2. J Stone et al., J Neurol Neurosurg Psychiatry 2005;76(Suppl I):i2–i12.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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