Dissociative seizures look like epileptic fits and such fits may be almost impossible to tell apart (at first sight) from fits caused by epilepsy. Unlike dissociative seizures, epileptic fits are due to abnormal electrical activity in the brain. During a dissociative seizure brain electrical activity remains normal ruling the seizure out as being due to epilepsy (in almost all cases). However, someone having a dissociative seizure cannot by themselves tell the difference between this kind of fit and an epileptic fit. The fit feels and seems to them and to others around them at the time of the seizure (like family or bystanders) like an epileptic fit.
Just like someone experiencing an epileptic seizure feeling that they have had a fit, someone suffering a dissociative seizure also feels the same. Neither wants to have a fit. Just like epileptic fits, dissociative seizures can start out of the blue and episodes can become very frequent and very disabling. Sufferers can do all the same things that happen in epileptic seizures such as convulse, bite their tongue, get injured, lose control of bladder and bowel, pass out and feel very groggy and tired when the seizure ends. Hence, the difficulty in deciding whether these are epileptic or non-epileptic in origin.
Seizures are more common in women than men and sometimes there may be a psychiatric history, such as self-harm or trauma, but this is certainly not always the case.
Specialised tests, such as video telemetry, are often carried out to ‘capture’ a seizure as it happens on video with simultaneous recording of brain EEG (electroencephalogram). In dissociative seizures, the EEG remains completely normal during the seizure.
It is often possible to diagnose dissociative seizures on the history, videos of the seizures and witness accounts. This, however, is best left to neurologists or very experienced neuropsychiatrists.