A 16-year-old girl presents with multiple unconsciousness. These started about six months ago and have become progressively worse. During the episodes, there is the jerky movement of the body but no urinary or faecal incontinence. These symptoms last for a few minutes and are followed by drowsiness. Neurological examination is normal. What differential diagnoses would you consider in this case? What other information would you enquire from the family about the episodes? Which specific investigations would you like to order? Differential Diagnosis Conversion disorder (F44.5 Dissociative convulsions) suggested by the episodes of unconsciousness and lack of findings on neurological examination and absence of incontinence. Epilepsy suggested by the recurrent brief episodes of unconsciousness, accompanied by jerky movements and followed by drowsiness Vasovagal syncope suggested by the brief episodes of unconsciousness, jerky movements (may occur) and normal physical examination Paroxysmal a

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-Epile