Clinical features

Watch out for pseudoseizures. 

These are more likely if ^c

• there is no clear cause for fitting
• the patient has a psychiatric history
• the patient is conscious yet having seizures with bilateral motor activity
• attacks seem atypical
• the patient resists examination
• the patient calls out 

Why?

Unexplained seizures, a psychiatric history or atypical fits increase the chance of a pseudoseizure

Patient	Target Disorder and Reference Standard	Diagnostic Test	LR+ (95% CI)	Post-test Probability	LR- (95% CI)	Post-test Probability
suspected pseudoseizure c (pre-test probability: -%)	pseudoseizure (diagnosed by a senior neurologist)	unexplained illness	infinity (3.0 to infinity)	-%	0.38 (0.19 to 0.76)	-%
		psychiatric history	10 (1.5 to 67)	-%	0.25 (0.092 to 0.68)	-%
		conscious yet having seizure with bilateral motor activity	8.0 (1.2 to 55)	-%	0.42 (0.21 to 0.84)	-%
		attacks thought atypical by staff	6.5 (1.8 to 23)	-%	0.0 (0.0 to 0.24)	-%
		resisting examination	4.5 (1.2 to 17)	-%	0.36 (0.16 to 0.85)	-%
		vocalisation	4.0 (1.0 to 15)	-%	0.45 (0.22 to 0.94)	-%