Differentiating Factors of Epileptic and Non-epileptic Fits

Factors That Favor Epileptic Fits

The following Favor epileptic fits. 

An abrupt onset
A stereotyped course lasting seconds to a few minutes.
Tongue biting, especially on the sides
Urinary incontinence during the fit
Evidence of cyanosis, for example, face turning blue.
Injury during the episode
Prolonged postictal confusion

Favour Non-Epileptic Fits

Treatment resistance to over two antiepileptic drugs.
Antiepileptics do not affect seizures.
Fits occur with specific environmental or emotional triggers.
Presence of witnesses, for example, family members at the time of an event.
History of chronic pain, fibromyalgia, chronic fatigue, syndromes.
History of comorbid psychiatric illness, personality disorder or substance abuse.
History of remote or current abuse or trauma.
Presence of repeatedly normal EEGs in the presence of recurrent seizures.
Drawn from Benbadis and LaFrance (2010).

Sociological features of Psychogenic Non-Epileptic fits

Gradual onset.
Rapid postictal re-orientation.
Undulating motor activity.
Side-to-side, head shaking.
Closed eyelids during the event.
An event lasting over two minutes.
Resisted eyelid opening.
Lack of cyanosis.
Partial responsiveness during a fit.
Drawn from Benbadis and LaFrance (2010) and Syed et al. (2011).

What are the points you would elicit to differentiate between epileptic and non-epileptic fits?
Does the fit present in diverse ways, or does it always present the same way?
What is the duration of the fits? Does that vary? 
Do you experience any post-ictal headache?
How do you feel after the fit? 
Do you think clearly or do you feel confused?
How soon do you recover after the fit?
Have you noticed any factors that trigger the fits? 
How frequently does the fit occur?
Has it ever occurred while you were sleeping, and someone noticed you having a fit?
Have you injured your tongue ever? Can you show me if the injury is to the side of your tongue?
Sometimes people may void urine because of the fits. Has that ever happened while you had a fit?
Has anyone noticed and told you that your face turned blue? 
Does it occur all sudden or do you feel like it will happen and then the fits happen?
Do you take any treatment for a psychiatric disorder?
Have you ever experienced an injury during the Episode?
Does the fit occur in a specific situation or place?
Is there any pattern to the episodes that you may have noticed?
Okay, this last question is slightly sensitive, but this is relevant so I must ask you: Do you have any childhood history of adverse experiences like punishment, abuse? The information you provide we always treat that confidential. Is there any history of sexual abuse? 

1. Anwar H, Khan QU, Nadeem N, Pervaiz I, Ali M, Cheema FF. Epileptic seizures. Discoveries (Craiova). 2020;8(2):e110-e110. doi:10.15190/d.2020.7
2. Benbadis SR, LaFrance Jr. WC. Clinical features and the role of video-EEG monitoring. In: Schachter SC, LaFrance Jr WC, eds. Gates and Rowan’s Nonepileptic Seizures, 3rd ed. New York: Cambridge University Press, 2010.
3. Syed TU, LaFrance Jr. WC, Kahriman ES, et al. Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol 2011; 69(6): 997-1004.