Which statement best differentiates a true seizure from a pseudoseizure?

• A. True seizures cause verbalization and preserved breathing; pseudoseizures do not
• B. True seizures cause inability to verbalize and impaired breathing; pseudoseizures do not
• C. Pseudoseizures always involve loss of consciousness
• D. Pseudoseizures are always accompanied by tongue biting

Answer: (B)

The main point is how breathing and speaking change during the event help tell a real seizure from a pseudoseizure. True generalized seizures typically involve a loss of consciousness with impaired or irregular breathing during the ictal phase, so the person cannot verbalize clearly while seizing. In contrast, pseudoseizures usually do not cause the same level of respiratory compromise, and the patient often maintains the ability to speak or respond during the episode. This combination—loss of verbalization and impaired breathing during a real seizure—best differentiates a true seizure from a pseudoseizure. Tongue biting can occur with true seizures but is not universal, and consciousness can vary with pseudoseizures, so those points aren’t as reliable for differentiation.