Postictal behaviors associated with psychogenic nonepileptic seizures

The postictal behavior of responding to questions in a whispering voice or responding to commands with partial motor responses has not, to our knowledge, been previously associated with psychogenic nonepileptic seizures. We performed a retrospective review of 100 consecutive patients admitted to the epilepsy monitoring unit for evaluation of medically refractory seizures or clinically indeterminate spells to determine if this association exists. Twenty-four patients had a diagnosis of psychogenic nonepileptic seizures, and 18 of the 24 (75%) exhibited postictal whispering voice or partial motor responses. None of the patients diagnosed as having epileptic seizures or other physiologic events exhibited these postictal signs. We conclude that postictal behavior may be helpful in the diagnosis of psychogenic nonepileptic seizures, and whispering or partial motor responses to commands may be commonly observed.