Pseudoseizures: ictal phenomena.

Videotapes of 71 pseudoseizures from 27 patients were reviewed and clinical phenomena were recorded. Twenty patients demonstrated decreased response to verbal stimuli; 15 described subjective phenomena; 22 had motor activity; 14 semipurposeful movements simulating epileptic automatisms; 19 alimentary phenomena; 9 respiratory change; and 12 nonverbal vocalization. Episodes could be divided into four major ictal patterns. Fifteen patients had bilateral motor episodes; three had unilateral motor episodes; eight had episodes with multiple behavioral phenomena; and three demonstrated episodes with an impaired response but no observable behavior. Eighteen of the 20 patients with multiple episodes had a stereotyped pattern. Individual phenomena often simulated epileptic activity; rarely did complete episodes closely resemble epileptic seizures.