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 movementsa | Gradual onset |
| Pelvic thrustinga | 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 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.