Functional neurological disorders: acute presentations and management

Article Figures & Data

Table 1.

Clinical features helpful in distinguishing epileptic from dissociative seizures.^7–9

Favour dissociative seizures	Not useful discriminators
Long (>5 min) duration of individual events	Tongue biting (except significant lateral tongue biting)
Fluctuating course (waxing and waning)	Incontinence
Asynchronous rhythmic movements^a	Gradual onset
Pelvic thrusting^a	Non-stereotyped ^c
Side-to-side head/body movements during a convulsion	Flailing/thrashing movements
Closed eyes	Opisthotonous
Ictal crying	History of associated Injuries
Recall of items during event^b

↵^aCan be seen in frontal lobe focal seizures.
↵^bPatients often report being able to hear what is going on around them but not being able to respond.^cClinical experience suggests that dissociative seizures are less stereotyped than epileptic seizures, but stereotyped attacks of itself does not argue strongly in favour or epilepsy. Features favouring epileptic seizures include prolonged post-event confusion and sterturous breathing.