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