Differentiation of generalized tonic-clonic seizures from pseudoseizures and syncope

Characteristic	Generalized seizure tonic-clonic	Pseudoseizure	Syncope
Circumstances
Situation	Awake or sleep	Awake	Usually upright; any position if cardiogenic
Precipitating factors	Sleep loss, alcohol withdrawal, flashing lights	Emotion	Emotion, injury, heat, crowds; none if cardiogenic
Presence of others	Variable	Usual	Variable
Motor phenomena
Vocalization	At onset, if any	During course	None
Location of motor component (if present)	Proximal limb	Proximal limb	None
Generalized motor	Tonic, then clonic	Tonic; flailing; struggling or thrashing, or both	Usually atonic; if syncope lasts >20 seconds: tonic, then clonic
Tonic posture	Partial flexion or straight	Opisthotonic	-
Head movements	To one side or none	Side to side	-
Clonus/limb jerks	Bilaterally synchronous	Asynchronous	Bilaterally synchronous
Purposeful movements	Absent	Occasional, including avoidance	Absent
Biting	Tongue, inside mouth	Lips, arms, other people	Tongue biting rare
Babinski's sign	Present	Absent	Absent
Autonomic features
Micturition	Frequent	Rare	Occasional
Eyes	Open	Closed	Open
Pupils	Dilated or hippus during attacks	Normal	Dilated
Colour	Cyanotic or grey	Rubor or normal	Pale
Pulse	Rapid, strong	Normal	Slow if vasovagal, weak if vasodepressor; that of arrhythmias if cardiogenic
Timing
Usual duration	1 to 5 min	5 to 60 min	1 to 2 min
Onset	Sudden	Gradual	Gradual; possibly sudden if cardiogenic
Sequence of symptoms	Stereotyped	Variable	Stereotyped
Termination	Spontaneous	Spontaneous or induced by supraorbital pressure, suggestion	Rapid
Sequelae
Injury	Frequent, mild; scalp, face, common	Rare, but multiple bruises possible; scalp, face, rare	If sudden onset
Postictal	Tired, confused, sleepy	Alert, emotional outburst	Regains consciousness in 2 to 3 min; alert but tired

Graphic 73515 Version 2.0

خرید پکیج

Differentiation of generalized tonic-clonic seizures from pseudoseizures and syncope