Attack features that can help to distinguish non-epileptic attacks from epileptic seizures. Reproduced from Reuber and Elger,3 with permission
| Observation | Non-epileptic seizures | Epileptic seizures |
|---|---|---|
| Situational onset | Occasional | Rare |
| Gradual onset | Common | Rare |
| Precipitated by stimuli (noise, light) | Occasional | Rare |
| Undulating motor activity | Common | Very rare |
| Asynchronous limb movements | Common | Rare |
| Purposeful movements | Occasional | Very rare |
| Rhythmic pelvic movements | Occasional | Rare |
| Opisthotonus, “arc de cercle” | Occasional | Very rare |
| Side-to-side head shaking | Common | Rare |
| Tongue biting (tip) | Occasional | Rare |
| Tongue biting (side) | Rare | Common |
| Prolonged ictal atonia | Occasional | Very rare |
| Ictal crying | Occasional | Very rare |
| Closed mouth in “tonic phase” | Occasional | Very rare |
| Vocalisation during “tonic–clonic” phase | Occasional | Very rare |
| Closed eyelids | Very common | Rare |
| Convulsion >2 minutes | Common | Very rare |
| Resistance to eyelid opening | Common | Very rare |
| Pupillary light reflex | Usually retained | Commonly absent |
| Reactivity during “unconsciousness” | Occasional | Very rare |
| Lack of cyanosis | Common | Rare |
| Rapid postictal reorientation | Common | Rare |