Table 1 Dissociative versus epileptic seizures, helpful and less helpful distinguishing features
Distinguishing featureDissociative seizuresEpileptic seizures
    Duration over 5 minCommonRare
    Gradual onsetCommonRare
    Fluctuating courseCommonRare
    Eyes and mouth closedCommonRare
    Resisting eye openingCommonVery rare
    Thrashing, violent movementsCommonRare
    Side-to-side head movementCommonRare
    Opisthotonus, “arc de cercle”OccasionalVery rare
    Visible large bite mark on side of tongueRareOccasional
    Dislocated shoulderRareOccasional
    RespirationOften fastCeases
    Grunting soundsOccasionalCommon
    Recall for period of unresponsivenessCommonVery rare
    Weeping/upset after a seizureOccasionalRare‡
Not so helpful
    Stereotyped attacksCommonCommon
    Attack arising from sleepOccasionalCommon
    Incontinence of urine or faecesOccasionalCommon
    Report of tongue bitingOccasionalCommon
    Pelvic thrustingOccasionalOccasional†
  • *Especially carpet burns and bruising; †frontal lobe epilepsy; ‡normally sleepy.