VALUE OF TONGUE BITING IN THE DIAGNOSIS OF SEIZURES

Background: Seizures are rarely witnessed by physicians, and the diagn osis is usually made on the basis of the history. Tongue biting is cla ssically considered to favor a diagnosis of epileptic seizure. The use fulness of tongue biting in the differential diagnosis of seizures was evaluated. Methods: A prospective study of the presence of oral lacer ations in 106 consecutive patients admitted to our Epilepsy Monitoring Unit and a retrospective study of a population of 45 patients with sy ncope were performed. The relationship between tongue biting and diagn osis (epileptic vs nonepileptic events) was analyzed. Results: Of the 106 monitored patients, 63 had episodes characterized by bilateral mot or activity, complete loss of consciousness, or both; 34 patients had epileptic seizures, while 29 patients had exclusively nonepileptic epi sodes. Eight patients suffered an oral laceration; all involved the si de of the tongue, and all had documented epileptic seizures. Of the 45 patients with syncope, in only one was the tongue lacerated, and this was at the tip. Tongue biting had a sensitivity of 24% and a specific ity of 99% for the diagnosis of generalized tonic-clonic seizures. Lat eral tongue biting was 100% specific to grand mal seizures. Conclusion : Tongue biting, particularly if it is lateral, is highly specific to generalized tonic-clonic seizures.