| Behavior | Psychological nonepileptic seizure | Epileptic seizure |
|---|---|---|
| Eye movement | Eyes closed at onset and during seizure; geotropic eye movement may be observed | Eyes open during seizure onset; may close briefly |
| Post-ictal nose rubbing and cough | Not present | May be present |
| Weeping | May be present | Not present |
| Body movements | Pelvic thrusting; out-of-phase or side-to-side oscillatory movements; chaotic and disorganized thrashing; ictal stuttering; post-ictal whispering | Pelvic thrusting; quick, tonic posturing; vocalization |
| Self-injury | May be present | May be present |
| Tongue laceration | May be present | May be present |
| Incontinence | May be present | May be present |
* Eyes open or closed? Using data from video-EEG monitoring, researchers found that:
* Ictal eye closure was 96% sensitive and 98% specific for diagnosing psychogenic nonepileptic seizures, the investigators found. link to article
* Serum prolactin drawn within 30 minutes of ictus onset is helpful for differentiating generalized tonic clonic seizures and partial complex seizures from PNES
* A pooled analysis of data from the literature shows that urinary incontinence has no value either in the differential diagnostic between ES and syncope/PNES.
Screening tool to assist in distinguishing between psychogenic nonepileptic seizures and epileptic seizures
| OBSERVED | EPILEPTIC FEATURES | NONEPILEPTIC FEATURES |
|---|---|---|
| A. Ictal Stage | ||
| Head movements | Fixed | Side to side |
| Eyes | ||
| Eyelids | Open | Closed |
| Light reflex | Absent | Present |
| Corneal touch | No response | Guarding response |
| Mouth | ||
| Vocalizations | No | Yes |
| Tongue injury | May bite the side(s) | May bite the tip |
| Limb movements | ||
| Synchronous | Yes | No |
| Continuous | Yes | No (with pauses) |
| Typical | Yes (tonic, clonic, or both) | No |
| Duration | 2–3 minutes | More than 3 minutes |
| B. Post-ictal Stage | ||
| Breathing | ||
| Deep | Yes | No |
| Regular | Yes | No |
| Loud | Yes (with snoring) | No |
| Duration | 5 minutes | 1 minute |
| Recall of episode events | No | Yes |
| Confusion | Yes | No |
| Headache | Yes | No |
| Fatigue | Yes | No |