These convulsions are of a psychogenic origin, also called psychogenic seizures or psychogenic non-epileptic seizures. These should be differentiated from true epileptic convulsions; hence the value of an eyewitness for the precise diagnosis of epilepsy. Simple information, that the patient had an attack of convulsions, is not enough to attach the label of epilepsy. The physician needs to know the details regarding the convulsions and other associated factors, for the immediate treatment of the case. Hence convulsions, whenever they occur, need to be watched carefully.

Epileptic convulsions occur suddenly, and before that a specific aural symptom may appear. On the other hand, hysterical convulsions are gradual and occur after vague symptoms/warnings. Moreover, hysterical convulsions have a strange look/style, and there is no sudden fall/injury during an attack of convulsion. Likewise, there is no tongue-bite or incontinence of urine, seen in cases of epilepsy.

After epileptic convulsions, the patient feels drowsy, and may sleep for hours, and is unable to recollect anything about the attack. In the case of hysterical convulsions, the patient may narrate the whole incident. It is significant to note that hysterical convulsions never occur during sleep. Further, hysterical convulsions are more common in young females, say in the age group of 20-30 years, and at times, it is observed that such patients have also a suicidal tendency.

Even while diagnosing childhood epilepsy, hysterical convulsions must be excluded, especially when the convulsions are generalized.

It may be said that one should not be perturbed whenever convulsions occur. Each convulsive attack needs to be analyzed and diagnosed. In some patients, both types of convulsions, i.e., epileptic and hysterical, may exist. Therefore, in a case of epilepsy, if in spite of giving proper dosages of suitable antiepileptic drugs, the convulsions are not controlled, such convulsions must be again watched carefully for the associated hysterical convulsions.

However, it is both wrong and unfair to label hysterical convulsions hurriedly as epileptic convulsions, since the patient may feel insulted or injured. This may further increase psychogenic/hysterical convulsions, besides involve an unnecessary trial of antiepileptic drugs.