What do non-epileptic attacks look like?

There are different types of NEAs. Some people experience a number of different types of attacks. The most common type of NEA look similar to an epileptic convulsion (a bilateral tonic clonic seizure, the type of seizures that used be called a "Grand Mal"). These NEAs involve jerking movements of arms, legs, head and trunk as well as loss of consciousness and dropping to the floor.

Some people lose control over their bladder, bite their tongue or injure themselves. Other NEAs involve less obvious stiffening or tremors.

In another common type of NEA, people go blank or stare. They may not move at all, or only move a little. These attacks resemble epileptic 'focal impaired awareness seizures' or fainting spells (attacks caused by a brief drop in the blood supply to the brain also called "syncope").

Most people appear unconscious in NEAD, although they may show signs of being able to react to their environment to some extent (such as turning to a person speaking to them, making gestures or other movements with a degree of purpose). Some may be able to talk whilst having an attack and follow commands. NEAs can be very short, lasting only a few seconds, or they can go on for much longer, sometimes lasting for hours at a time.

Research has shown that the symptoms people experience in their NEAs can be affected by the causes of their attacks. For example, people whose NEAs started after serious emotional trauma are more likely to experience longer attacks with shaking of the whole body, emotional triggers, flashbacks, seizure injuries or incontinence.

There are subtle differences between non-epileptic attacks and epileptic attacks. These are not always present (or they may not be present in all attacks). There is no single attack observation which tells and observer with certainty that a particular attack must be caused by epilepsy or be a NEA. Doctors consider the combination, timing, nature and order of different manifestations when they distinguish between epileptic and nonepileptic attacks.

The main differences are:


Duration: 0.5 to 2 minutes

Pelvic thrusting: Rare

Eyes/mouth: Typically open

Side-to-side head movement: Rare

Tongue biting: Occasional

Crying during the attack: Rare

Talking during the attack: Rare


Duration: Often longer than 2 minutes

Pelvic thrusting: Occasional

Eyes/mouth: Often closed

Side-to-side head movement: More common

Tongue biting: Occasional

Crying during the attack: More common

Talking during the attack: More common

Differences between non-epileptic attacks and epileptic seizures have been described for hundreds of years. This is a 19th Century drawing showing arching of the back which is more common in non-epileptic attacks.

Adam says: “My attacks consisted of head jerking, arms and legs flaying, my hands and feet contorting so much that they hurt, losing control of my legs, I also used to go into a trance, I could hear things around me but was unable to come around.

Tina says: “I do not seem to fit, just remain still although my eyes flicker rapidly. When I regain consciousness I am very disorientated, shivery, depressed, hurt, have a bad headache and tired. I usually have to take to my bed for up to 48 hours.