Clinical signs

Ability of observer to modify motor activity Asynchronous limb movements Avoidance behavior during seizure Change in semiology/nonstereotypic seizure patterns Closed eyes during seizure Dystonic posturing (including opisthotonus)

Emotional/situational trigger Gradual onset and cessation Ictal crying, weeping If tongue biting present, usually tip, not side of tongue Intermittent or waxing & waning motor activity Nonphysiologic progression Pelvic movements (especially forward thrusting)

Prolonged seizure (>2 - 3 minutes)

Resisted eyelid opening Seizures provoked by suggestion Side-to-side head movements