The diagnostic value of oral lacerations and incontinence during convulsive “seizures”

Abstract

SUMMARY

Tongue biting in epileptic seizures and psychogenic events

“…However, oral lacerations and TB may occur both in seizures and in PNEEs. Although a lateral TB has been reported to be highly specific for epileptic seizures [1,2], a comprehensive search of the literature to determine the accuracy of this physical finding (with special regard to its positive likelihood ratio) and its prevalence in epileptic seizures and in PNEEs has not yet been performed.…”

Psychogenic non-epileptic seizures: A challenging entity

“…Lacerations have been identified in 26% of patients of epileptic seizures with a 100% specificity versus PNES. 40 Objective evidence of tongue bite was found in 23.5% of patients with ES. Lateralized tongue bite was considered to be 100% specific to ES.…”

“…Thus, emphasis should be placed on objective evidence of injury and incontinence, which may be more supportive of ES than historical information. 40 Although significantly less common than in ES, injuries such as lacerations and fractures have also been reported by patients with PNES. 43 One patient from our practice sustained an unintentional traumatic subdural hemorrhage during a PNES.…”

Seizure Semiology: An Overview of the ‘Inverse Problem’

“…The same applies for urinary incontinence [69], which seems more common after convulsions (probably following a sudden rise in intra-abdominal pressure). Incontinence is also encountered in seizures arising from the parasagittal portion of the fontal lobe [45].…”

“…In our experience, it is not rare to observe concomitant hyperventilation with a positive Chvostek sign on gentle percussion of the facial nerve during the spell; furthermore, generally there is no intervening cyanosis even after prolonged convulsions of nonepileptic origin. While oral lacerations (including tongue bites), and, to a lesser extent, urinary incontinence have been shown to be highly suggestive of epileptic seizures, or less frequently of syncope, since these signs are only rarely seen after PNES [69], at times patients with PNES may be hurt during their spells. It is therefore strongly advisable not to rely solely on these features in diagnosing nonepileptic seizures: in this context, ictal semiology alone shows a rather low inter-rater agreement even among experienced epileptologists [85].…”