The diagnosis of non-epileptic attacks (NEA) is often challenging, the main differential being epilepsy. The gold standard test for diagnosis is combined video-EEG recording during a patient's typical attack. However as this is a limited and expensive resource, with no guarantee of capturing an event, the history remains key to discriminating these attacks from epileptic seizures. Traditionally, the presence of tongue biting is considered highly suggestive of epileptic seizures, particularly if it is on the side rather than the tip. In practice, we find patients with NEA frequently report tongue biting, including lateral. It isn't known if this is due to misrecall, inadvertent ‘coaching’ by serial history-takers, or whether this represents a true finding. We present two patients with confirmed NEA who had documented evidence of lateral tongue biting, which to our knowledge has not been reported previously. We also review the evidence to date on specificity of LTB for epilepsy. We suggest that LTB may not be as helpful a feature for distinguishing epilepsy from NEA as currently thought.
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