Faking seizures?

[Grodo]

Hello everyone,

I came with a question I've been asking myself for a few days ... maybe someone here can help.

I work at an adult education center (disclaimer: not a nurse!).There is a studentl there (age 28) who regularly has seizures. I've only seen it happen a few times in the 2+ years that this person has been with us, but she says that it actually happens quite often (1-2 times a month). She has always been quite adamant that we not call an ambulance when a seizure hits, so we never had until now. This past Wednesday, though, she had multiple seizures in relatively rapid succession, and that time we did call an ambulance.

By the time the ambulance came (about fifteen minutes after we called, since they had a bit of trouble finding us), the student was talking in full sentences and appeared extremely tired, but otherwise OK. It may have been another five minutes or so between her having the seizure, and us deciding that we were going to make that call.

Among other things, the ambulance crew asked her what medications she was on, and she said Tegretol. I happen to know this is an actual anti-seizure med. My grandson took it for a while.The ambulance crew asked me to describe what had happened, and I did, as best I could. In hindsight, one of the most striking things, to me, was how this student repeatedly struck her head against the pavement.

After a while, though, one of the paramedics began asking me questions I hadn't really expected. Like whether she had talked or sat up while seizing. It seemed to me he was implying that the seizure might be fake. I did a bit of internet research and found, on this forum among others, that some people apparently do, in fact, fake seizures for attention. The thing about this student is that she seems more bothered than pleased when people hover over her.

But then again, that paramedic got me thinking. There are a few things that seem weird about this situation. Like for instance: she is a crutch walker and an occasional wheelchair user. I have never witnessed her having a seizure while on crutches; always in the chair. And I don't often see her in the chair. Being in the chair means that she won't fall to the ground abruptly, even while having a seizure. Also, I witnessed my grandson having a tonic-clonic seizure twice, and both times, it took him at least an hour to come fully out of it. With this student, it's fifteen minutes at most. What seems especially weird to me is that she's always trembling all over her body after a seizure (not right after, but within minutes, as she tries to get back to work). Aren't her muscles supposed to be exhausted and therefore limp?

If she is indeed faking the seizures, I'd like to know. If attention is what she's after, it seems to me we souldn't be giving it to her anymore. Maybe then the fake (?) seizures might stop.

[ixchel]

@ixchel:

I believe, going by my newly gained knowledge of different types of seizure activity, that your description of walking into an ER while having an active seizure, means your seizures are (sometimes?) simple partials.

My student has generalized seizure activity (tonic-clonic attacks): something I had seen before in my grandson. That previous experience predisposed me towards expecting the same thing in someone else. This student's seizures seem different, though, not so much during, but definitely after. As I've said before, that threw me off.

I can see now, though, that as you say, it is not my place to judge. Moreover, I've had responses here from people who have experience with clients who have both CP and epilepsy, making me see that the two conditions can influence each other and create something "weird", which even the EMT may never have seen before. I no longer think this person is faking her seizures. But to be honest, that doesn't put my mind at ease. It makes me more scared for her than I've ever been.

My apologies to you, Ixchel, if my initial post, and maybe some of the ones after, have offended you.

After reading more of your posts, I realized that my initial response to you was a bit harsh. I think I'm the one owing you the apology, love :)

I think it is a wonderful thing that you have taken the time to learn about this, and I hope that you have the opportunity to share information with those you work with.

Ensuring she has been safely lowered to the floor, and that there is nothing nearby that might cause injury, is important. Turn her to her side if you fear she is in risk of choking on food or saliva. I know that we are not allowed to give medical advice here, but hopefully that is interpreted as safety and prevention of injury, and not medical advice.

If you feel like you're starting to geek out on this, you probably will really enjoy just learning about the brain in general. Every area controls different things, as you probably know, and when you understand in detail what each area does, you can imagine what happens when something goes wrong in that area. For me, having left temporal lobe epilepsy, this area of the brain involves the encoding of new memories, language comprehension and the naming of things.

The episode that led to my diagnosis occurred when I increased a medication that lowered my seizure threshold. I repeatedly went into epilepticus (multiple nonstop seizures, which can be life threatening) over the period of a week. Remember, as I mentioned, I can walk and talk through them, so I was begging medical professionals to help me, and kept being told I was simply having anxiety. I finally went to the ED, where I had an astute MD pay attention to me, and I was put onto the road to diagnosis. It took awhile for me to isolate what seizures actually "felt" like for me. It took a couple of months for my brain to recover. I was terrified I'd be trapped in my broken mind permanently. I kept forgetting absolutely everything, and randomly it would take me a very long time to remember what things were called. I got used to describing things so people would know what I was talking about. Another thing that this area of the brain does when it is injured is cause olfactory hallucinations. Even though my memory is now intact and words are no longer a struggle since beginning Vimpat, I still randomly smell things. I've gotten into the habit of no longer asking, "What's that smell?!"

Fascinating stuff!

[zombienurse13]

Pseudo Seizures is a common diagnosis in the Psychiatric Field, which I think is totally ridiculous, I don't understand why the doctors don't call these patients out and say stop faking seizures, instead they play into it and now have named it. This is one of the problems with the world today!

[morte, LPN, LVN]

fake is not the same as pseuo

The behaviors you described don't definitively point to an answer either way. Fake seizures, or "pseudoseizures," are pretty common. In a hospital, people figure out it's a pretty easy way to get both attention, and IV Ativan.

If this girl had been having seizures, she has probably had CTs and other diagnostic studies done. The patients I've had that repeatedly have fake seizures haven's had any antiseizure meds prescribed, so the fact that she did have meds may mean a physician has been able to make a definitive diagnosis. It could also mean she has a PCP who doesn't feel like arguing with her.

I've had patients actually press the call button to tell me they're having a seizure. They'll talk during the "seizure." It's like they never even took the time to look it up on Wikipedia or watch a YouTube video to try and make it seem legitimate. I had one guy who didn't seem to understand what his diagnosis of pseudoseizures really meant, and I could tell by the way he talked about it that he thought it meant we all believed him, that he had tricked the system.

Since it's a relatively common occurrence to fake seizures, it doesn't surprise me that EMS asked you these questions. I think, though, that they probably ask these questions most of the time they get these calls, and not just because they thought your patient might have been lying.

It's still important to treat all seizure-like activity as the real thing. Personally, I don't consider thrashing around, while yelling and asking people for things, to be seizure-like activity...I stay with the patient and get vital signs afterwards, but there's no yelling for help or overriding Ativan in the Pyxis. At this point, I would definitely still be taking your patient seriously, and I think you were right to call EMS for the second one.

If you want more answers and it wouldn't be inappropriate for you to do so, ask this girl what her CTs have said, or what her neurologist has diagnosed her with. If she does have a diagnosis, it could be helpful to know what kind of seizures she has.

[amethystJsmn]

So so many nurses dont get a pseudo seizure is a seizure. For example if a patient Ods on a med and seizes... pseudo seizure. Also, dont assume you have a pet who isnt having seizures just because they can function. You obviously need to study more on the subject if you believe you are capable of determining a false seizure. A dx of pseudoseizure is real. Also a partial complex seizure isnt shown to have tell tell signs you can see. Listen to your pets. Stop pretending to be a neurologist.

[Slipping CMA]

Let me start by saying I’m just a CMA so I have no real medical training like you nurses do when it comes to seizures.

I grew up with an uncle that had epilepsy ( he lived with us ) my DH is type 1 diabetic, my daughter had febrile seizures as a baby and my son inherited my uncles epilepsy.

Depending on the reason for the seizure will depend on your reaction. If this is an epileptic seizure like my son and uncle it can take a while to come back out of it. For my son after a grand mal type of seizure it takes him at least 30 minutes to be himself again. ( same with my uncle ). If after an hour he is not himself we call 911 because for them it means another seizure is on its way, and who knows when it will really stop. In my experience hospitals will give 1000 mg Keppra IV and an anti anxiety medication that I can’t think of the name of right now but it can also help with seizures.( it’s related to clonozapam ) I’m just saying a trip to the ER is not a waist of time, they can be very helpful.

My one question is, if she is having them this frequently why aren’t they adding to her medication? I am only speaking from personal experience and not medical knowledge, but most neurologist that I have interacted with have a goal of trying to completely control the seizures. Sometimes one medication isn’t enough.

I guess you could try asking for her to get an action plan from her neurologist. This would answer a lot of questions. With both my son and my uncle a seizure itself lasting 5 minutes is a call to 911, but we’ve never experienced that. ( knocking on wood ).