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Table 1 Selected differential diagnoses (modified from [12])

From: SOP: First-ever epileptic seizure in adult patients

  Epileptic Seizure Syncope Dissociative Seizure Parasomnia Paroxysmal Movement Disorder Migraine (aura)
Duration 30–120 s 10–30 s seconds to hours seconds to minutes seconds to hours 4 to 72 h
Eyes open open (tightly) closed open open open
Motor signs automatisms, tonic, clonic, versive, tonic-clonic irregular myoclonic and tonic convulsions crescendo and decrescendo, variability from event to event few targeted automatisms dystonia, dyskinesia (athetotic, choreatic) normal (exception: hemiplegic migraine)
Speech ictal aphasia (dominant hemisphere) no abnormalities after syncope stuttering no abnormality possibly abnormality no abnormality
Initiation possibly aura (seconds) vegetative prodromi (min.) varies, possibly prodromal spells none tension oder paraesthesia possibly aura
Re-orientation often delayed rapidly often delayed and “stuttering” none if returns to sleep rapidly gradually
EEG epileptiform discharges (or normal) normal (or general slowing) normal certain patterns from Non-REM or REM-sleep normal normal (or non-specific slowing)
Triggers rarely, then stereotype (e.g., flicker light) shock, pain, micturition, etc. suggestion drugs possibly physical activity, coffeine, tea, training stress, hormones, red wine, etc.