Faking seizures?

dream'n, BSN, RN · Dec 13, 2014

I have no idea whether this person is or is not having seizures. I will say that it is not extremely uncommon for people to fake seizures. In those people that do fake, it is very common for them to have extremely ingrained manipulative behaviors that only a qualified, trained therapist will be able to help. For safety's sake, treat her seizures as real.

SubSippi · Dec 13, 2014

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.

SubSippi · Dec 13, 2014

I also just looked it up online, and according to what I found on the internet, it's possible to have an actual seizure that's not epileptic. So they wouldn't have the same postictal s/s that you saw with your grandson. This does not mean that they're purposely faking, but that the seizure are not caused by changes in the brains electrical activity. These non-epileptic seizures may also be diagnosed as pseudoseizures, or psychogenic nonepileptic seizures (PNES), so a diagnosis of pseudoseizure doesn't always mean someone is faking, as the name might indicate.

Just something to think about!

Grodo · Dec 13, 2014

@SubSippi: she's told me that she has tonic-clonic seizures. I also know that she had a brain biopsy done recently. Or in any case, she's been coming to school wearing a hat for a week or two, and our policy is no hats inside the building. We're letting her keep the hat now, because of the biopsy story. But that seems to be for an unrelated problem (double / unclear / periodically disappearing vision), which she was also complaining of on the same day as the seizures.

Weird thing: she was absent for only one day when she was supposedly having the biopsy done. Really? Also, while having her seizures, she lost the hat at one point, and I saw no obvious scars or bandages on her head. I don't know. It just smells fishy to me.

jadelpn, LPN, EMT-B · Dec 13, 2014

There are people with serious and chronic mental illness who, among other things, have what appear to be "seizures".

Tegratol is also a mood stabilizer, therefore, could be taken for that purpose.

Chronic personality disordered people will, as a part of their disease process, be ill, submit themselves to multiple tests, to find a cure for their illnesses (perceived or not).

In my opinion, people who are personality disordered are so due to significant, long term, and serious trauma. So regardless of if the seizures are "real" or not the attention seeking behaviors are due to a very real mental illness. That is exceedingly difficult to treat. Focus on function, coping skills...but again, very difficult.

I would, however, per your facility protocol, set some firm boundries. Should this person have any sort of seizure activity, an ambulance will be called for transport, every time, as it should be. The act of this person stating that they do "not want an ambulance called" is manipulative, and can put the facility at risk, the licensed personnel at risk, and is not great practice.

Finally pseudo-seizures are very real to the person they are happening to. It is a coping skill developed from a place of trauma based mental illness.

Grodo · Dec 13, 2014

OK, so the prevailing wisdom seems to be that for whatever reason, she's probably having pseudo-seizures, and that those should be taken seriously too. Noted. Thanks for your responses.

I just don't know about her. She broke her glasses during that first seizure, which I didn't witness because she was out taking a leak at the time. The glasses were a total loss, and replacing them will probably cost her quite a tidy sum. That doesn't strike me as something someone would do just for effect. But on the other hand, I'm clueless as to how her glasses could have gotten that messed up, in that particular pattern of brokenness, while she was having the same kind of seizure I've always witnessed. And I definitely think the quick return to alertness, and the shivering, are weird. If she's having any kind of post-seizure confusion at all, in my experience it's never lasted longer than ten minutes. And do any of you know whether shivering is a normal post-seizure thing for some people?

It's also the fact that she supposedly has so many different medical problems. Apparently, the crutches and the wheelchair are due to cerebral palsy (which, OK, not that uncommon ... we've had people like that before, but all of them were walking), combined with the effects of a bad break to her right knee, followed by a bone infection. Then there's the vision problems, and allegedly epilepsy, and a bad back (she says it's a hernia), and something about her liver that makes her refuse OTC pain medication every time we offer it. Mind you, she never asks of her own accord!

There's definitely something wrong with her. But for some reason, I don't think it's exactly what she claims it is ...

jadelpn, LPN, EMT-B · Dec 13, 2014

Personality disordered people do all of the above. This is a mental illness. What you describe can be symptoms of the same.

The breaking of the glasses, the epilepsy, the countless medical issues--all related to abandonment fears, attention seeking....and all part of mental illness in personality disordered people. This person believes themselves to be absolutely in the right, and an average person would look at all of this as "what the heck"- but to this person, this is "normal" life.

Personality Disorders and Personality Traits

JustBeachyNurse, LPN · Dec 13, 2014

I've seen people post ictal after EEG verified tonic-clonic grand mal seizures for 15 minutes or less, and 1-2 hours. I've seen seizures requiring respiratory support as they are hypo-ventilating. I've seen absence seizures ("staring spells") with post ictal states ranging 5-90 minutes. It all varies by condition.

I think the best answer should be policy dictating that in a non-medical facility any witnessed seizure- like activity EMS should be called unless specific orders are written by the facility physician or neurologist (such as administer Diastat after 10 min of witnessed seizure activity and call EMS. ) why assume it's a fake or pseudoseizure and be wrong? You can't always compare to a child's post ictal state.

dishes, BSN, RN · Dec 13, 2014

She is alternating between mobility aids because she has cerebral palsy, herniated disc, broken knee, infected bone, in other words physical disorders. Vision can fluctuate with cerebral palsy. If she has elevated liver enzymes (possibly from the tegretol) she should not take OTC that contain acetaminophen. The seizures were probably assessed by EEG before she was prescribed tegretol, so I would not assume the seizures are conversion disorder.

amoLucia · Dec 13, 2014

Just to add my 2 pennies - I feel the same as you and the other posters. There's some things that seem to be diagnostic of a real seizure disorder, but then some others are 'iffy' at best.

I remember my first witnessed seizure at about my age of 8 or 9 or so. My kid sister was 'febrile convulsive' until she was about 10 or 12 y/o. I vividly remember seeing my Dad dipping her thrashing little body into chilled bathwater. She was like a little rag-doll, just limply hanging there after the seizure. Every time she got sick with anything, my folks were ever so vigilant about her temp (which didn't have to be high). She outgrew the condition.

There was one other sign of seizure activity that I used to believe indicated true seizures - the pt would often be incontinent of urine (maybe BM too). Then I learned that really manipulative 'fakers' would DELIBERATELY be incontinent just to get their seizure meds. Same thing about 'auras' which are really easy to fake.

dishes, BSN, RN · Dec 13, 2014

If she had a stereotactic brain biopsy, she could have been discharged from hospital the same day and the dressing over the area small, also the dressing may have been discontinued at the time you saw her head. I think you are doing her a disservice making assumptions about her medical conditions.