. Author manuscript; available in PMC: 2020 Jun 14.

Published in final edited form as: JAMA Neurol. 2018 Sep 1;75(9):1132–1141. doi: 10.1001/jamaneurol.2018.1264

Table 1.

Ictal Semiology in Nonepileptic vs Epileptic Seizures

Examination Features	Common in PNES, Rare in ES	Common in ES, Rare in PNES	May Be Present in Either
Eyelids and pupils
Closed	Yes	No	No
Open	No	Yes	No
Fluttering	No	No	Yes
Resistance to eyelid opening	Yes	No	No
Absent light reflex	No	Yes	No
Preserved pupil reflex	No	No	Yes
Eyes rolled up	No	No	Yes
General phenotype
Duration longer than 2 min	Yes	No	No
Opisthotonus	Yes	No	No
Asynchronous limb movements	Yes	No	No
Side-to-side head shaking	Yes	No	No
Prolonged event with falling down and lying still with eyes closed	Yes	No	No
Guttural cry at onset	No	Yes	No
Visible tongue bite	No	Yes	No
Synchronous limb movements	No	Yes	No
Clonic jerking	No	Yes	No
Highly stereotyped movements^a	No	Yes	No
Self-injury	No	No	Yes
Urinary incontinence	No	No	Yes
Report of tongue biting	No	No	Yes
Nocturnal seizures	No	No	Yes
Postictal behaviors	Yes	No	No
Rapid reorientation	Yes	No	No
Prolonged atonia	Yes	No	No
Whispering	Yes	No	No
Crying	Yes	No	No
Slow reorientation	No	Yes	No
Stertorous breathing	No	Yes	No
Impaired communication	No	No	Yes

Abbreviations: ES, epileptic seizures; PNES, psychogenic nonepileptic seizures.

In patients with PNES, events can be stereotypical in up to one-third of patients, even if the collective range of events is wider in this population.