Functional seizures: differentials

Evidence-based neurology checklist on functional seizures: differentials: Generalized tonic-clonic seizures These have a consistent semiology The movements are synchronous There is no pelvic thrusting There are no side-to-side head or body movements The eyes are open during the episodes There may…

Generalized tonic-clonic seizures

  • These have a consistent semiology
  • The movements are synchronous
  • There is no pelvic thrusting
  • There are no side-to-side head or body movements
  • The eyes are open during the episodes
  • There may be lateral tongue biting
  • They are less likely to last >5minutes unlike in psychogenic seizures
  • There is post-ictal stertorous breathing: this strongly suggests organic seizures
  • There is postictal amnesia for the episodes
  • There is post-ictal confusion
  • The course is not fluctuating

Other differentials

Synonyms

References

  1. Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? JNNP2010; 81: 719-725.
  2. Muthusamy S, Seneviratne U, Ding C, Phan TG. Using semiology to classify epileptic seizures vs psychogenic nonepileptic seizures: a meta-analysis. Neurol Clin Pract 2022; 12:234-247. 
  3. Seneviratne U, Minato E, Paul E. How reliable is ictal duration to differentiate psychogenic nonepileptic seizures from epileptic seizures? Epilepsy Behav 2017; 66:127-131. 
  4. Sen A, Scott C, Sisodiya SM. Stertorous breathing is a reliably identified sign that helps in the differentiation of epileptic from psychogenic non-epileptic convulsions: an audit. Epilepsy Res 2007; 77:62-64. 
  5. Azar NJ, Tayah TF, Wang L, Song Y, Abou-Khalil BW. Postictal breathing pattern distinguishes epileptic from nonepileptic convulsive seizures. Epilepsia 2008; 49:132-137.
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