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SUMMARYPurpose: To increase understanding of the subjective symptomatology of seizure experiences and improve differential diagnosis by studying the seizure metaphors used by patients with (psychogenic) nonepileptic seizures (NES) and epilepsy. Methods: Twenty-one unselected patients taking part in this study were admitted for 48 h of video-EEG (electroenceophalography) observation because of uncertainty about the diagnosis. Eight were proven to have epilepsy, 13 to have psychogenic nonepileptic seizures (PNES). During their admission, patients were interviewed by a neurologist. A linguist blinded to the medical diagnosis identified and categorized all seizure metaphors in verbatim transcripts. Between-group comparisons and logistic regression analysis were carried out. Results: Of 382 metaphors identified, 80.8% conceptualized seizures as an agent/force, event/ situation, or space/place. Most patients used metaphors from all categories, but patients with epilepsy and PNES showed preferences for different metaphoric concepts (differences p = 0.009 to p = 0.039). Patients with epilepsy preferred metaphors depicting the seizure as an agent/force or event/situation. PNES patients more often used metaphors of space/place. Logistic regression analyses predicted the diagnosis of PNES or epilepsy correctly in 85.7% of cases (based on different metaphor types in the each category) or 81.0% (based on all metaphor tokens). Discussion: Patients with epilepsy and PNES have different preferences in the metaphoric conceptualization of their seizures. Epileptic seizures are described as a more external, self-directed entity than PNES, which are depicted as a state or place patients go through. The differentiating value of metaphoric conceptualizations suggests that metaphor preference could form the basis of future diagnostic questionnaires or other diagnostic tools.

This study illustrates the importance of the time point at which patients share information with the doctor. It supports the notion that close attention to how patients communicate can help in the differential diagnosis of seizures.

This paper presents the results of an investigation into the distribution of phonetic variants of the Dutch discourse marker eigenlijk, combining phonetic and conversation analytic methods. The paper shows that the phonetic form of eigenlijkdepends to some extent on the sequential environment in which the item is used; moreover, it shows that in the case of two such environments, the forms of eigenlijk are representative of tempo and reduction patterns spanning entire turns or turn-constructional units. These patterns can be related to the interactive function of the turns; thus, the findings presented here contribute to our as yet limited knowledge of the phonetic correlates of communicative actions.

We present an analysis of the use of diagnostic labels such as seizure, attack, fit and blackout by patients who experience seizures. While previous research on patients' preferences for diagnostic terminology has relied on questionnaires, we assess patients' own preferences and their responses to a doctor's use of different labels through the qualitative and quantitative analysis of doctor-patient interactions in a realistic clinical setting. We also examine whether two subgroups of patients -those with epileptic seizures and those with (psychogenic) nonepileptic seizures -show different behaviours in this respect. Our findings suggest firstly that patients make fine lexical distinctions between the various diagnostic labels they use to describe their seizure experiences; secondly, that patients play an active role in the development and application of labels for their medical complaint; and thirdly, that attention to patients' lexical choices and interactive use or avoidance of labels can be relevant for the differential diagnosis of seizures.