Closed eyes during a seizure indicate psychogenic etiology: A study with suggestive seizure provocation

Psychogenic seizures are often difficult to distinguish from epileptic seizures. A saline infusion test with suggestion is a useful tool for diagnosis because psychogenic seizures can be elicited in about three-fourths of patients. We analyzed 100 psychogenic seizures provoked by suggestion in patients with and without a history of epileptic seizures. Most patients showed bilateral movements of the limbs, including head movements and pelvic thrust, mimicking generalized seizures. Ninety percent of patients had closed eyes, an uncommon feature during an epileptic generalized seizure; 10% of patients had open eyes. These patients frequently had a history of epileptic seizures. Suggestive provocation proved a safe and reliable diagnostic tool.