To the Editor.
—Although Gates et al1 found that eye movements were not helpful in distinguishing real seizures from pseudoseizures, they did not mention the incidence of geotropic eye movements. Movement of the eyes toward the ground has been found to be very helpful in distinguishing hysterical states of unconsciousness, including coma and syncope as well as seizures.2,3The test is done by observing the patient's eyes during active turning of the head from side to side. During a pseudoseizure, patients usually make several irregular voluntary saccades before staring toward the ground, away from the observer. Turning the head in the opposite direction results in more voluntary saccades before the eyes come to rest facing in the opposite direction.A true seizure may result in movement of the eyes to one side or the other, but turning the head back and forth would not change the direction of
Rosenberg ML. Geotropic Eye Movements and Pseudoseizures. Arch Neurol. 1986;43(6):544. doi:10.1001/archneur.1986.00520060008005
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