21st June 2023

Features of non-epileptic seizures

	Non-epileptic seizure	Epilepsy
Duration	Prolonged (>2 minutes-up to an hour)	Short (seconds-minutes)
Stereotypy	Variable – motor features that wax and wane in 60% and a prolonged period of unresponsiveness after falling to the ground in 40%	Stereotypical
*Warning*	Often – in about 50%. Present as chest pain, palpitations, sweating, tingling or numbness, or derealisation or depersonalisation.	Rare
*Possible Triggers*	Random, at rest when not distracted, hyperventilation and with depersonalisation or derealisation	Flashing lights or hyperventilation
*Cyanosis*	Rare	Possible
*Incontinence*	Rare	Common
*Tongue biting*	Rare	Common
*Injuries*	Rare	Possible
*Eyes*	Easily opened	Hard to open
*Awareness*	Common	Possible
*Recall of events*	Possible	Rare
Associated with a psychological event	Common	Rare
Video telemetry	Variable with some of the above features	Stereotypical with abnormal concurrent EEG
Ictal and post-ictal EEG	Normal	Abnormal
Post-ictal Prolactin level	Slightly raised	Very high after a tonic-clonic seizure or after a complex partial seizure
Response to AEDs	Short-lived	Excellent

When giving the diagnosis of NES to a patient and their carer, the following are key points to discuss :

Reasons for concluding they do not have epilepsy – results of tests and what they mean, etc.
What they do have (describe what dissociation is and why it can develop)
Validating their experiences and reassurance that they are not ‘putting it on’ – one of the primary fears/judgments of patients with dissociative or functional disorders feel
The triggering “stress(es)” might not be clear
The aetiological factors in their case
Maintaining factors
Caution that if on an AED that its withdrawal should be done gradually
Describe psychological treatment

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