In epilepsy, semiology is the analysis of the different symptoms and signs of seizures. Despite the tremendous advancements in neurophysiology and imaging, semiology as a clinical tool remains the cornerstone of any evaluation for a patient presenting with paroxysmal spells. This is highlighted by the fact that epilepsy is a clinical diagnosis based on the occurrence of seizures with ancillary testing used to support and not replace the semiological analysis. Furthermore, semiology plays a big role in distinguishing epileptic seizures from nonepileptic spells. In this chapter we present a case of a patient who had both epileptic and nonepileptic seizures with overlapping features. We discuss how semiology can help the clinician distinguish between those entities and subsequently lead the clinical management.