Ictal heart rate differentiates epileptic from non-epileptic seizures.

Video-EKG-EEG recordings of 67 epileptic seizures and 38 psychogenic nonepileptic seizures were reviewed. Ictal heart rate (HR) was higher during and after epileptic seizures for both convulsive and nonconvulsive spells (p < 0.01). When analyzing quiet staring spells separately, it was possible to identify which spells were epileptic in origin with a positive predictive value of 97% by using a cutoff of a > or =30% increase in HR over baseline. It was concluded that documenting an increase in HR during a spell of unresponsiveness usually can distinguish between epileptic and psychogenic causes.