R/O Seizures

Um, an EEG?

Our "seizure fakers" are a little smaller and not as "mature" as yours most likely are. I usually try the holding down of one limb or part of a limb- if I am able to, or the original type of movement of the limb changes or weakens... not a seizure. And I totally agree- sometimes you just know.

i would wonder if the patient in the OP didnt start with pseudo sz, and finding the attention a good think progressed to "faking".......

How about the 'hand over the face'?? Usually I try this with our "unresponsive kiddos, but it has worked with some "seizure" pts. But like I said... ours are a little less mature.

a pseudo seizure responds to pain (I do a sternal rub)

they stop when you are out of the room, and increase with family present

they track your motions with their eyes while seizing

sometimes they stop if you tell them to.

It's hard to say. Had a neurosurgeon show me and about 25 other experienced ICU nurses a video of "seisures" and we had to give our opinion as to whether they were real or not. We were shocked at what some of the actual seisures looked like, and of what some of the hard core fakers could do. One lady (a faker) could make herself foam at the mouth and would bite her tongue to bleeding! Another pt (real seisure) simply turned his head slowly to one side with a normal gaze then return his head to midline. It was fascinating, and the neurosurgeon made a good point--never assume....get the EEG.
Wish I could post a link to this video--it was when Keppra came out and was sponsored by the manufacturers. Anyone else ever see it?