In a youngster with a history of "seizures", which of the following would be most suggestive of a nonorganic or hysterical etiology:
Hysterical episodes stimulating seizures rarely are associated with bodily injury, incontinence, or postictal sleep. The pseudoseizures frequently are triggered by bizarre stimuli, and the pattern of the seizure changes often. The patient actually is awake and aware of his or her surroundings and events and can recall them later. Pseudoseizures usually can be distinguished both clinically and by the electroencephalogram (EEG) findings. In patients with pseudoseizures resembling tonic-clonic attacks, there may be warning and preparation before the attack; there is usually no tonic phase, and the clonic phase consists of wild thrashing movements during which the patient rarely comes to harm or is incontinent. Ictal eye closure is common. In some instances, there are abnormal movements of all extremities without loss of consciousness; in others, there is shouting, uttering of obscenities, or goal-directed behavior during apparent loss of consciousness. There is no postictal confusion or abnormal clinical signs after the attack. The EEG, if recorded during an episode, does not show organized seizure activity, and postictal slowing does not occur. Ref: Greenberg D.A., Aminoff M.J., Simon R.P. (2012). Chapter 12. Seizures & Syncope. In D.A. Greenberg, M.J. Aminoff, R.P. Simon (Eds), Clinical Neurology, 8e.
Postictal sleep
Changing pattern of the seizure
Biting of the tongue during an episode
Urinary incontinence during an episode