2.6. Pseudoseizure
One of the great diagnostic difficulties of complex partial seizures of temporal or frontal lobe origin is pseudo seizures. Flagrant major motor seizure patterns are the characteristic clinical symptom complex, but any form of seizure may be simulated. Approximately 40–60% of patients with pseudo seizures have documented real seizures. The personality traits and psychopathology noted with complex partial seizures are frequently noted.
Patterns of Involvement of Facial Muscles during Epileptic and Non-Epileptic Events
- Eyes are wide open in greater than 90% of patients during the tonic phase of tonic-clonic seizures
- Eye closure in any form is uncommon during the ictal phase of an epileptic seizure with motor manifestations
- Psychogenic seizure have sustained eye closure with active opposition to opening
- Mouth is open during the tonic phase of a generalized seizure; injury to the tongue and side of the mouth is common (usually side of the tongue is bitten)
- During seizure: eyes may have upward gaze deviation; empty stare, pupillary dilatation and absence of the corneal reflex
- Rapid forced blinking with no other facial movement-focus is occipital lobe in origin
- Focal seizure with tonic contraction of corner of the mouth or zygomaticus muscles (cheek) M1 of the frontal lobe
- Rhythmic forced contraction of the face occurs with seizures
- Tongue biting (side of the tongue) contralateral to seizure focus; occurs in the clonic phase of GTCS
- Cheek biting occurs during automatisms
Epileptic Seizure May Progress into Non-Epileptic Conversion Seizures
- Common for epileptic seizures to become functionally elaborated into a conversion seizure; possibly 30–60% of true seizures have pseudo seizures
- Precipitating factors:
- Physical and sexual abuse
- Life stressors
- Disability
Features Associated with Pseudoseizures
- Absence of usual provoking event
- Abnormal distribution and pattern of movement
- Pelvic thrusting
- Thrashing of the arms
- Forced eye closure that is maintained during examinations
- Absence of post ictal phenomena
- Preictal pseudo sleep
- Gradual onset
- Induced by suggestion
- Crying
- Opisthotonus
- Asynchronous
- Emotional triggers
- Associated with psychiatric diagnosis
- Side to side head movements
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