Main clinical features of tonic-clonic seizures compared with the convulsive type of functional seizures

Clinical feature	Generalized tonic-clonic epileptic seizures	Convulsive functional seizures
Frequency	Variable	Infrequent convulsive functional seizures are unusual
Duration	Usually <2 min excluding postictal phase	Brief convulsive functional seizures are unusual
Eyes	Open/half open	Usually closed
Motor activity	Generalized tonus followed by generalized clonic activity	Alternating movement or tremor, occasionally thrashing, back arching, side-side head movement; tonic features uncommon
Vocalization	Initial, inarticulate, no emotional features	During and after seizure, conveys distress
Autonomic signs	Cyanosis	Signs of arousal and hyperventilation, flushed, pale
Postictal phase	Drowsy, confused, sleeps, severe headache	Often back to alertness quickly; distress
Incontinence of urine	Reported and observed	Commonly reported
Sleep events	Commonly reported/observed, events may occur only during sleep	Commonly reported/observed, but not EEG verified; events reported to occur during sleep only highly unusual
Injury	Commonly reported/observed	Less commonly reported/observed
Burns	Thermal	Friction
Tongue/mouth injury	Bite to lateral tongue or inside of cheek, observed injury	Reported bite to tip of tongue
Stereotypy	Usual	Common

Not all features distinguish between tonic-clonic seizures and the convulsive type of functional seizures; no single feature is sufficiently sensitive or specific to be used alone.

EEG: electroencephalogram.

Courtesy of Roderick Duncan, MD, PhD, FRCP.

Graphic 131637 Version 3.0

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Main clinical features of tonic-clonic seizures compared with the convulsive type of functional seizures