Differentiation of hysterical fit from epileptic fit

Clinical Features Epileptic Seizures Dissociative Convulsions (Hysterical Fits) 1. Attack pattern Stereotyped, known clinical patterns Absence of any established clinical pattern. Purposive body movements occur 2. Place of occurrence Anywhere Usually indoors or at safe places 3. Warning Both prodrome and aura are stereotyped Variable 4. Time of day Anytime. Can occur during sleep Never occur during sleep 5. Tongue bite Usually present Usually absent. Cheek and lip bite may be present 6. Incontinence of urine and faeces Can occur Very rare 7. Injury Can occur Very rare. If occurs, it is minor or may be accidental 8. Speech No verbalisation during the seizure Verbalisation may occur during the fit 9. Duration Usually about 30-70 sec. (Sho) 20-800 sec. (Prolonged) 10. Head-turning Unilateral Side to side turning 11. Eye gaze Staring, if eyes are open Avoidant gaze 12. Amnesia Complete Paial 13. Neurological signs Present, e.g. up-going plantars Absent 14. Post-ictal confusion Present Absent 15. Stress Present in 25% Present much more often 16. EEG - Inter-ictal - Ictal Usually abnormal; Abnormal Usually normal Normal 17. Serum prolactin Increased in post-ictal period (15-20 minutes after seizure; returns back to normal in 1 hour) Usually normal Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 101