Table 2

 Attack features that can help to distinguish non-epileptic attacks from epileptic seizures. Reproduced from Reuber and Elger,3 with permission

ObservationNon-epileptic seizuresEpileptic seizures
Situational onsetOccasionalRare
Gradual onsetCommonRare
Precipitated by stimuli (noise, light)OccasionalRare
Undulating motor activityCommonVery rare
Asynchronous limb movementsCommonRare
Purposeful movementsOccasionalVery rare
Rhythmic pelvic movementsOccasionalRare
Opisthotonus, “arc de cercle”OccasionalVery rare
Side-to-side head shakingCommonRare
Tongue biting (tip)OccasionalRare
Tongue biting (side)RareCommon
Prolonged ictal atoniaOccasionalVery rare
Ictal cryingOccasionalVery rare
Closed mouth in “tonic phase”OccasionalVery rare
Vocalisation during “tonic–clonic” phaseOccasionalVery rare
Closed eyelidsVery commonRare
Convulsion >2 minutesCommonVery rare
Resistance to eyelid openingCommonVery rare
Pupillary light reflexUsually retainedCommonly absent
Reactivity during “unconsciousness”OccasionalVery rare
Lack of cyanosisCommonRare
Rapid postictal reorientationCommonRare