The diagnostic value of oral lacerations and incontinence during convulsive "seizures".
OBJECTIVE
Oral lacerations and urinary incontinence have long been considered useful clinical features for the diagnosis of epileptic seizures; however, both are also reported in patients with psychogenic nonepileptic seizures (PNES). The aims of the study were (1) to investigate whether the presence and nature of oral lacerations or incontinence during convulsive seizures of patients with epilepsy differed from those with PNES, and (2) whether the side of the oral laceration has any correlation with the epilepsy syndrome or lateralization.


METHODS
Eighty-four consecutive patients who experienced at least one convulsive event during video-EEG monitoring (VEM) were questioned and examined for oral lacerations and incontinence. Seizure classification was determined by a team of epileptologists based on the VEM findings and other clinical and investigational data, blinded to the oral laceration and incontinence information.


RESULTS
The presence of oral lacerations among patients with epileptic seizures was 26% (17/66), in contrast it was 0% (0/18) with PNES (p = 0.01). Of the oral lacerations sustained by patients during an epileptic seizure, 14 were to the side of the tongue, one to the tip of the tongue, two to the cheek, and three to the lip. No significant relationships were observed between seizure lateralization and oral lacerations. Incontinence occurred in 23% (15/66) of epilepsy patients and 6% (1/18) of PNES patients (p = 0.09). There was no relationship between epilepsy type or lateralization and the prevalence of incontinence.


CONCLUSIONS
Despite frequent reports of oral lacerations and incontinence by patients with PNES, objective evidence for this is highly specific to convulsive epileptic seizures.
Oliva
Megan
M
Department of Neurology, The Epilepsy Service, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
Pattison
Claire
C
Carino
John
J
Roten
Annie
A
Matkovic
Zelko
Z
O'Brien
Terence J
TJ
D000328:Adult; D001734:Bites, Human / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000453:epidemiology; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology; D004829:Epilepsy, Generalized / Q000175:diagnosis / Q000453:epidemiology; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D022125:Lacerations / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D009055:Mouth / Q000293:injuries*; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000453:epidemiology; D013223:Statistics as Topic; D014059:Tongue / Q000293:injuries; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology*; D014741:Video Recording