Listening to people with seizures: How can linguistic analysis help in the differential diagnosis of seizure disorders?


  • Meike Schwabe University of Sheffield
  • Markus Reuber University of Sheffield
  • Martin Schöndienst Bethel Epilepsy Center, Bielefeld, Germany
  • Elisabeth Gülich Professor Emeritus, FU Berlin and University of Bielefeld



epilepsy, non-epileptic seizures, linguistic analysis, , subjective experience, narrative, metadiscourse


Despite advances in medical technology, the patients’ history remains the most crucial tool in the differential diagnosis of epileptic or non-epileptic seizures (NES). The distinction of these two types of seizures is a common and important task for neurologists. Whereas epileptic seizures would be treated with antiepileptic drugs, non-epileptic seizures are thought to be a manifestation of psychological or social distress and can improve with psychotherapy. This paper summarizes the findings of a series of multidisciplinary research studies undertaken at the Bethel Epilepsy Centre and the University of Bielefeld in Germany in which linguistic analysis was carried out to identify and describe linguistic and interactional features in clinical exchanges between doctors and patients with seizures. Two distinct communication profiles emerged in these studies based on the analysis of transcripts of over 110 doctor-patient encounters. Epileptic seizure descriptions are characterized by formulation effort, provide the doctor with a coherent account of individual seizures, relate subjective seizure experiences and use consistent metaphoric conceptualizations. Patients with NES tend not to volunteer subjective seizure symptoms, give accounts of their seizures which are difficult to understand and are inconsistent in their choice of metaphors.

Author Biographies

Meike Schwabe, University of Sheffield

Meike Schwabe is a postdoctoral research associate at the University of Sheffield. As a linguist with a particular interest in Conversation Analysis and medical interactions she has participated in interdisciplinary research collaborations focusing on seizures and anxiety in Germany and the UK. In her Ph.D, she examined the interaction between doctors and children or adolescents with seizures. She showed how the description of subjective seizure experiences by young people can contribute to diagnosis and treatment.

Markus Reuber, University of Sheffield

Markus Reuber is a Senior Clinical Lecturer at the University of Sheffield, UK, and Honorary Consultant Neurologist at the Sheffield Teaching Hospitals NHS Trust. He trained as a neurologist and epileptologists in Leeds, UK, and Bonn, Germany. His clinical practice focuses on the diagnosis and treatment of epileptic and non-epileptic seizure disorders. His academic interests include the etiology and treatment of non-epileptic seizures, co-morbidity in patients with epilepsy and doctor–patient communication.

Martin Schöndienst, Bethel Epilepsy Center, Bielefeld, Germany

Martin Schöndienst heads the Department of Psychosomatic Epileptology at the Bethel Epilepsy Center in Bielefeld, Germany. His postgraduate training included clinical attachments in the Departments of Neurosurgery and Neurology at the University of Berlin (West). He is a board certified specialist in psychiatry and psychoanalysis. His interests include chronic encephalopathies, epileptic seizure semiology, the differentiation of paroxysmal disorders with linguistic methods, anxiety disorders and concepts for psychosomatic treatment of patients with epileptic or dissociative seizures

Elisabeth Gülich, Professor Emeritus, FU Berlin and University of Bielefeld

Elisabeth Gülich is Professor Emeritus of Text Linguistics, FU Berlin (1979–1981) and of French and General Linguistics, Faculty of Linguistics and Literature, University of Bielefeld (1981–2002). Her current research areas encompass Conversation Analysis, narrative analysis and medical communication. She initiated and participated in interdisciplinary collaborations on the linguistic differential typology of epileptic and other seizure disorders and the communicative description and clinical representation of anxiety in patients with epilepsy or anxiety disorder.



How to Cite

Schwabe, M., Reuber, M., Schöndienst, M., & Gülich, E. (2008). Listening to people with seizures: How can linguistic analysis help in the differential diagnosis of seizure disorders?. Communication and Medicine, 5(1), 59–72.