There was a patient/IM that had a possible seizure and the staff that responded were claiming that it was fake because she was alert and oriented.

How do you handle this situation, and how do you know the difference between real vs fake seizures?

I know there are different kinds of seizures. I am new to the jail population of patients and am trying to be safe with the real seizures vs the manipulators.

Specializes in ortho, hospice volunteer, psych,.

The amount of ignorance demonstrated in this thread is absolutely appalling to me. Contrary to popular belief, one does not have to lose consciousness, flail around, bite one's tongue, etc. to have had a legitimate seizure.

How do I know that?

It's very very simple. I have epilepsy as the result of having had several congenital aneurysms. Two of them ruptured when I was a baby and I had a massive CVA that resulted in the seizure disorder. Because I was so young, I recovered virtually completely, except for the complex partial seizures. Meds controlled them entirely until decades later when another aneurysm ruptured. My meds were changed and adjusted and I am almost completely seizure free. Triggers now are the same as before this last CVA: humid weather, being to hot, an elevated temp, being startled by someone suddenly comes up behind me without speaking to me, staying up too late,

alcohol use. Even the alcohol in mouthwash will get me.

My seizures consist of vice grip strength facial tightening, (which part of my face is affected depends upon which cells are firing.) I can still talk, follow a conversation completely, but sometimes have a headache afterward, or feel tired.

I did have abdominal seizures before I was switched to Keppra. They cause pain in the right upper quadrant, nausea, diarrhea, and just a general "yuck" feeling. Again, no loss or impairment, or speech issues. No flailing or bladder loss either.

I realize people do try to fake seizures for a variety of reasons. I worked psych too long not to know that. I just get frustrated when people insist there's only one kind of seizure or that you must lose consciousness, flail about, and lose bladder control, and bite their tongues, because it just isn't true!

Just for the sake of some poor soul that actually does have epilepsy that you are TORTURING for having a medical condition that you all have not looked into:

There's over 20 different types of seizures there still is very little known about the brain and how it functions. People like the majority of this thread hear the word "seizure" and think dead off tonic clonic in the floor foaming biting etc. Those are actually not as common as the other types of seizures that people do experience. Some yes only experience those and some experience others.

Epilepsy Seizures Are Divided Into 3 Main Categories.

Generalized

...as I stated above; the whole brain is a affected.

Partial Seizures:

Only PARTS of the brain are affected but what makes this so special for you guys? Is CONSCIOUSNESS REMAINS. So yes these people can indeed be acting a total fool and having seizures. These are a fair deal more common. ESPECIALLY when most people think when they hear the word seizure. These are more common then tonic clonic seizures WHY? They haven't made it all the way across the brain. People have been actually misdiagnosed as being schizophrenic if that says anything.

Complex Partial Seizures:

All that I have stated with partial seizures but consciousness is LOST. I think this is what you are looking for with "other types of seizures". People have actually gotten up wondered out of their houses into the middle of the road and gotten hit by cars.

There here is my lecture for hopefully at least one soul with legitimate seizures that you do not torture.

I'm going to leave all of this at one last comment:

if you maul a person's sternum to death and they wake up from a real seizure that's got to be pretty bad. Same as ice. Imagine this yourself. I have seizures if you have not noticed I have been called crazy I have done the stupidest things you can possibly think of. I have bitten off half of my tongue. I have fallen and hurt myself so many times you can't imagine FORTUNATELY this doesn't happen EVERYTIME.

The generalized seizures hurt more than you can imagine so let's toss some ice on that?

Specializes in Complex pedi to LTC/SA & now a manager.

I've witnessed absence seizures and partial seizures knowing the individual well enough that something was wrong but not aware without an EEG running that they were actively seizing.

Depending on the part of the brain involved vital signs might not change from baseline.

Do not do a sternal rub during what you think is a fake seizure. Even if a fake seizure and person is dramatic flailing all about keeping the person safe not causing pain is the priority.

Look up gelastic (sp) seizures. Another "non-obvious" seizure often un/mis diagnosed. Gelastic and Dacrystic Seizures

Specializes in Corrections, long term care, clinic.

Ammonia inhalant works every time for me. Once I had one try to hold their breath so they wouldn’t react, but could only hold their breath so long. Sure enough as soon as they inhaled it was game over. In the two years I’ve been nursing corrections I’ve seen more “seizures” and “chest pain” than I’ve seen in my entire life. And in all of those instances, I’ve only seen ONE legitimate seizure.. I don’t think I’ve ever had an abnormal EKG either. 

Specializes in Dispensary.

When I have an inmate say they had a seizure, it is usually after the fact. I rarely have the CO call and tell me that an inmate is CURRENTLY having a seizure. A quick review of their history (once they are stable) can help. Do they have an ETOH or seizure history??

The safest thing is usually to get them stabilized as you would any seizure (turn them, do a neuro assessment, get them oriented) and then let them spend the night in the infirmary with qh or q 15m observation, depending on their LOC. If they're faking it, then they get 24h in observation, which is basically like isolation, no TV. If they're not faking, then you did the right thing by taking them to the clinic.

Just my opinion.

Specializes in Correctional, QA, Geriatrics.

If that is the case then combine wafting the inhalant with a good sternal rub. Or just bypass the inhalant and use the rub. That is a tender area and rotating the knuckles briskly is virtually impossible to ignore if conscious.

For myself I never had a failure with the inhalant because I broke it right under the nose and left it there for several seconds before I moved it. The concentrated fumes are very difficult to ignore with either a flinch, grimace or copious tearing.

Thanks for all the information. I laughed at the instant miracle.

One trick a coworker shared is rubbing a handful of ice on the person's belly. If they're faking they recover instantly, and most of the time they start to "come out of it" when you loudly ask the nearest officer for a handful of ice. I've never actually tried it, but there were no fake seizures on that nurse's shift!

Specializes in Hospice, corrections, psychiatry, rehab, LTC.
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One of my favored methods for sorting out the real from the fake was an ammonia inhalant.

This is our method of choice. It really separates the fakers.

Specializes in Case Manager/Administrator.

We respond in a fashion that is evidenced based to include lab theraputic values, then if this behavior continues well it becomes a safety issue for our patients and they must wear a helmut while awake so they do not hurt themselves. Females will almost always have noseizures after the topic of helmuts come up. Men it takes one or two episodes before they get it.

Again we respond always like it is real, you never know.

Specializes in Hospice, corrections, psychiatry, rehab, LTC.
Two Sheds said:
I laughed at y'all's comments about the smelling salts because I have started to use those and they truly are "miracle workers" lol.

They have helped us to separate a lot of the pretenders.

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What's crazy is that we have a couple of inmates who are so predictable that the COs will call us in medical saying, "I/M ____ is going to have a seizure in 5 minutes...just a heads-up." Sure, enough, it happens. And they are such BAD actors! They come out of the "seizure" and they'll be like, "Wh- wh- where am I?" Nauseating, but funny as heck!

I was doing pill call on the yard one night. For some reason, we started about 45 minutes later than usual. While out on rounds, I got a call from an officer on a unit we hadn't visited yet, saying that an inmate in his unit was asking where his medications were. This particular inmate was notorious for fake seizures. I told the officer that we were running about 45 minutes late, but that we would be there. Not five minutes later, there was a man down call from this unit. We suspended pill call and went to the unit to find this inmate flopping on the floor of his cell like a beached halibut. I looked at him. "Knock it off." He stopped, sat up and looked at me. "Aren't you going to give me my meds?", he asked. "No, and I will be writing a notice of charges for abuse of the man down system. And by the way, you have delayed pill call for yourself and everyone else on this yard by another 45 minutes."

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This is how we outed this one malingerer: the Dr. came to the unit when the emergency was called, and he observed as we stated things like, "I don't know...if it was a real seizure, his jaw would be jutting out more," and the I/M jutted his jaw out. Then we said, "Yeah, his right leg would be at more of an angle" and other ridiculous, fake "symptoms." Every symptom we mentioned, the I/M would start doing. The Dr. finally ordered that next time he has a "seizure," he is to be put into the turtle suit (the green suicide getup) and put into the observation room for 4 hours. That room is FREEZING so it took only 1 time in there for him to be "cured."

This is brilliant. I love the creativity that went into this.

One thing I used to do, especially on night shift, is give malingerers what I call "concrete therapy". The two large holding cells at the front of our clinic have concrete benches - hard, uncomfortable and very cold in the winter. If a malingerer came to the clinic (seizures and chest pains, two of the most popular symptoms to fake, were the usual reasons they were there), I would leave him in the holding cell for 3-4 hours after the clinic visit for observation. When the inmate asked when he was going back to his cell, I would tell him that I had to observe him long enough to make sure that he was OK to return to the yard. Punishment? Yes, but easily medically justifiable. That cured a lot of our late night visitors.

itzvalerie said:
I loved using ammonia inhalants! Then when I started working at a chemical treatment facility for adolescents there was one client who they claimed to have "seizures". They kept sending her out to the ER, repeatedly! I was tired of this & pulled on my corrections knowledge, grabbed some ammonia inhalants, cracked them & put them to her nose. It cracked me up to see her try to hold her breath then turn red, sit up & "come out of it".

More recently, I have been working in a psych facility and have to agree that ammonia inhalants come in mighty handy there.

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