Table 1.

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

Favour dissociative seizuresNot useful discriminators
Long (>5 min) duration of individual eventsTongue biting (except significant lateral tongue biting)
Fluctuating course (waxing and waning)Incontinence
Asynchronous rhythmic movementsaGradual onset
Pelvic thrustingaNon-stereotyped c
Side-to-side head/body movements during a convulsionFlailing/thrashing movements
Closed eyesOpisthotonous
Ictal cryingHistory of associated Injuries
Recall of items during eventb
  • 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.