EAN 2026 | Distinguishing epileptic from non-epileptic events: clinical and electrophysiological features
Gordana Kiteva-Trenchevska, MD, PhD, Ss. Cyril and Methodius University in Skopje (UKIM), Skopje, North Macedonia, shares insights into electrophysiological and clinical features that can distinguish epileptic seizures from non-epileptic paroxysmal events. On an electroencephalogram (EEG), specific interictal and ictal changes occur in epileptic seizures that are often missing in non-epileptic events. Clinical features can overlap between epileptic and non-epileptic events; however, duration and clinical presentation can be used to distinguish between events. This interview took place at the 12th Congress of the European Academy of Neurology (EAN) in Geneva, Switzerland.
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Transcript
Electrophysiological features that are characteristic for differentiating epileptic seizures from non-epileptic events or mimics are EEG features and we can register interictal or ictal changes and they are very specific for the epileptic seizures and they are missing usually in non-epileptic events but unfortunately these features cannot be registered every time. They are limited in time or in place...
Electrophysiological features that are characteristic for differentiating epileptic seizures from non-epileptic events or mimics are EEG features and we can register interictal or ictal changes and they are very specific for the epileptic seizures and they are missing usually in non-epileptic events but unfortunately these features cannot be registered every time. They are limited in time or in place. Sometimes we have to make several EEGs to detect all the specific features for epileptic seizures. And with increasing the number of EEG recordings, we can increase this possibility to register these specific ictal or interictal changes. And they are different. It depends on the type of epileptic seizures. And the clinical features overlap sometimes between epileptic seizures and a non-epileptic event and sometimes it is really difficult but there are some characteristics for example the time duration of non-epileptic features, they usually last longer than epileptic seizures. They are very short. For example, if there are some focal seizures, they may last a very short time, but the period after the seizure may be longer and may be confusing with some non-epileptic seizures. And other features that differentiate not just time but the clinical presentation for example the eye closure, it’s characteristic for some functional dissociative seizures. And in epilepsy, usually eyes are opened. The patient with functional dissociative seizure is not collaborative. But when we try to open the closed eyes, he tries to close them. So it is something that is characteristic for this type of seizure. But the differences in clinical presentation depend on the type of epilepsy mimics. I was speaking here about functional seizures, but there may be other types, for example, transitory ischemic attacks or maybe aura in migraine with aura, usually they last longer.
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