Postictal symptoms help distinguish patients with epileptic seizures from those with non-epileptic seizures

The aim of the study was to assess whether post-ictal symptoms can help dis tinguish patients who have epileptic seizures from those with non-epileptic seizures (NES). We reviewed the spontaneous responses to the question 'Wha t symptoms do you have after a seizure?' in 16 patients with epileptic seiz ures (predominantly focal with secondary generalization or generalized toni c-clonic) and 23 NES patients. Six of the 16 patients (38%) vs, only one of 23 NES patients (4.3%) noted post-ictal headache (P = 0.008). Nine epileps y patients (56%) vs, three NES patients (13%) reported post-ictal fatigue ( P = 0.004). Confusion or other symptoms did not distinguish epilepsy patien ts from those with NES. All epilepsy patients had at least one post-ictal s ymptom while 12 NES patients (52%) had none (P = 0.001). Therefore, patient s evaluated for epileptic vs. non-epileptic seizures who have post-ictal fa tigue or headache, are more likely to have epileptic seizures. Patients wit h a diagnosis of NES who note post-ictal fatigue or headache should be inve stigated further.