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. Evidence of significant injury during an attack has traditionally been associated with epileptic seizures. It is widely presumed that a patient with NEA has sufficient level of awareness to allow them to avoid painful stimuli such as burns, before they produce significant harm. This is despite previous reports in the lietrature of significant injury in NEA. To remind clinicians of the dangers in making this presumption, we present two cases of patients with confirmed NEA who have had witnessed evidence of burns injuries during a typical attack. We suggest that this should not perhaps be as surprising as it may seem, given subconscious or conscious self-harming is accepted as a typical manifestation of emotional disorders. Indeed, one of our cases admitted specifically to deliberately putting himself in high risk situations. We suggest that the presence of significant injuries better reflects seizure disorder severity, rather than diagnosis.
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