Abstracts

The distinction between epileptic and non-epileptic seizures can be very challenging in the absence of EEG-video monitoring with recorded seizures. Discriminating ictal features described in the literature often cannot be used in the clinic while obtaining the history. Overwhelmed observers often miss ictal details. Postictal signs could prove easier to identify. We observed that the postictal breathing after non-epileptic seizures with generalized motor activity is considerably different from the postictal breathing pattern of generalized tonic-clonic seizures. We evaluated this feature in consecutive patients admitted for EEG-video monitoring., We reviewed seizures recorded with video-EEG in consecutive adult patients with epilepsy and patients with non-epileptic psychogenic seizures. We reviewed 22 generalized tonic-clonic seizures in 15 patients with epilepsy and 22 convulsive non-epileptic seizures in 15 patients with pure psychogenic seizures. We analyzed the altered postictal breathing pattern for rate, depth, regularity, loudness, and duration. We used the Fisher exact test to compare groups for categorical variables and the student t-test to compare them for continuous variables., The breathing after generalized tonic-clonic seizures was deep with prolonged inspiratory and expiratory phases, regular, and usually loud (except for two short seizures). The breathing after convulsive non-epileptic seizures was characterized by increased respiratory rate or hyperpnea with short inspiratory and expiratory phases, as can be noted after exercise. The breathing was often irregular, with brief pauses. The altered breathing lasted longer after epileptic tonic-clonic seizures. The two groups differed significantly in loudness of postictal respiration, postictal snoring (only with epileptic seizures), respiratory rate (mean of 30/min for the epileptic group and 44/min for the psychogenic group) and duration of altered breathing (mean of 6 min for the epileptic group and 1.6 min for the psychogenic group) (p[lt]0.00001 for all features)., The postictal breathing pattern can help differentiate generalized tonic-clonic seizures from non-epileptic psychogenic seizures and may be helpful to the practitioner obtaining a seizure history in the clinic setting, or witnessing a seizure.,