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.
Forgot to add - One thing about the 'ambulance not needed' thing. Up to now, maybe all her 'seizures' have been mild??? She may be counting on that fact so as to avoid a trip to the hospital ER with possible admission. Maybe she really doesn't want to make a big thing out of her seizures. Great until a big one does happen ...
Doesn't this facility require any sort of medical history form? It's very possible that all of her conditions are physiological. Often times, one condition can lead to another.
@blondy: No. As per privacy law, we can only ask about medical history before taking people on an overnight trip, which happens sometimes in compulsory education, but never (or almost never) with us. And even then, we are obligated to discard the forms as soon as the trip is over. There's a separate entity that does regular (bi-annual) medical check-ups on schoolchildren. They will inform the school if there's something they really need to know. But that does not apply to adult education, either.
Also, there's no guarantee of accuracy, unless the form has been filled out by a GP or something. When I was a scout leader, I once had a thirteen-year-old at summer camp who had filled out her medical history form herself, then had it signed by her parents, and finally added some more stuff that her parents never saw. It's how she made us believe she was deathly allergic to a long list of foods that she just didn't like.
But OK. Medical professionals have told me she could in fact be suffering from all these things at once. I will act upon her seizures accordingly. Thank you all.
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 wouldn't read too much into this. This is one of the questions the ED doc/nurse will ask the paramedic. Since you did not, I presume, go to the hospital, this is the one chance to gather that information which may be important to the care of this individual once they reach the ED. More than likely, this is just experience on the part of the medic asking the question--he has taken Sz. patients to the ED before, he knows that the ED staff is going to want to know, so he asks these questions at the scene to witnesses. It can also help to differentiate a syncopal episode from a true seizure.
There is a distinct difference between "faking a seizure" a pseudoseizure, and epilepsy. Faking a seizure is something anyone can do. With a pseudoseizure, a person is not really faking it. A pseudoseizure is the body's response to a psychological stressor. It can look exactly like a seizure but if the person is placed on an EEG, it will be normal during the "seizure." The treatment for pseudoseizures is working with psychology/psychiatry to address and deal with the stressor.
Epilepsy is an electrical storm on the surface of the brain. Seizures can be focal or generalized and may look different from person to person depending on what part of the brain is affected. A seizure can start as a partial seizure and spread to a generalized seizure. There are no rules for what the seizure looks like or how long it should take to recover.
A person can have both pseudoseizures and epilepsy! It is important to give anyone the benefit of the doubt that appears to be having seizure like activity. Protect their head from injury. Never put anything in their mouth. Protect their airway by rolling them on their side. Time the event and note what the event looks like.
Like others have said, Tegretol can be given for several reasons. The spell could have been anything but I would err on the side of caution. If it lasted for longer than 5 minutes, I personally would call the squad unless there was a documented medical reason not to.
There is a distinct difference between "faking a seizure" a pseudoseizure, and epilepsy. Faking a seizure is something anyone can do. With a pseudoseizure, a person is not really faking it. A pseudoseizure is the body's response to a psychological stressor.
I imagine, then, that anyone can also say they are having a "pseudo-seizure" instead of faking it. Mind you, after hearing all of your opinions, I no longer think that this student is faking it. I'm just saying, "pseudo-seizure" seems like a cop-out to me.
Thing is, the person herself has told me, and colleagues at the school, that not a lot can be done about her seizures. I've only seen five, including the one on Wednesday. But all of them have lasted under a minute, followed by ten to fifteen minutes of unresponsiveness, and then she's back. She's been incontinent for urine exactly once, and has never bitten her tongue in my presence.
Speaking seems tiring for her when she's first coming out of a seizure, but she's invariably making jokes and telling us we're being way too fussy within twenty minutes of having had a seizure. It looks pretty strange to me, but I guess it's possible even for a true epileptic ... In any case, if she's faking, she's probably not doing it for the Ativan. On Wednesday, I heard her refuse to let the EMT's hook up an actual IV to the needle they put in her arm, "because I know you'll want access, but I'd like to avoid all medication that's not strictly necessary."
What's even stranger is that fifteen minutes after a seizure, she can usually talk, but not do much of anything else. She has heightened muscle tone and, like I said, has a tendency to shiver after a seizure, which I had never seen or heard of before this girl (well, at 28 I suppose she's not really a girl anymore, but you get the picture). But then again, I'm not a medical professional, which is part of the reason I came here with this story. I suppose, as I'm finding out, anything goes with seizures.
There is a distinct difference between "faking a seizure" a pseudoseizure, and epilepsy. Faking a seizure is something anyone can do. With a pseudoseizure, a person is not really faking it. A pseudoseizure is the body's response to a psychological stressor. It can look exactly like a seizure but if the person is placed on an EEG, it will be normal during the "seizure." The treatment for pseudoseizures is working with psychology/psychiatry to address and deal with the stressor.
Epilepsy is an electrical storm on the surface of the brain. Seizures can be focal or generalized and may look different from person to person depending on what part of the brain is affected. A seizure can start as a partial seizure and spread to a generalized seizure. There are no rules for what the seizure looks like or how long it should take to recover.
A person can have both pseudoseizures and epilepsy! It is important to give anyone the benefit of the doubt that appears to be having seizure like activity. Protect their head from injury. Never put anything in their mouth. Protect their airway by rolling them on their side. Time the event and note what the event looks like.
Like others have said, Tegretol can be given for several reasons. The spell could have been anything but I would err on the side of caution. If it lasted for longer than 5 minutes, I personally would call the squad unless there was a documented medical reason not to.
I realize that there can be a difference between a pseudoseizure, and someone who is just faking. But out of curiosity, do you know how an MD would be able to differentiate the two, if there aren't any definitive tests to diagnose a pseudoseizure?
Before entering this conversation, it seemed to me that a pseudoseizure diagnosis was given mostly to appease a patient who was unwilling to accept "Nothing is wrong with you." The reason I thought this was because I have had several patients with pseudoseizure in their health history, who were clearly faking. And before anyone says I don't know and shouldn't assume...let me just say, I am referring to behavior such as coming out to the nurse's station, gently lying themselves on the ground, and then flailing around. Or finding out how often they could get Ativan, and then pressing their call light to tell the nurse they were having a seizure q4h on the dot.
Grodo, in my experience, it is rare that someone admits they have pseudoseizures (a.k.a. Conversion disorder). Families often become quite defensive that their child's seizure is "real" and cannot possibly be a psychological problem.
You do not have to be incontinent with a seizure. You do not have to have an extended recovery time. In fact, you can be fully conscious and still have a seizure. Simple partial seizures may manifest as just a feeling of déjà vu. Myoclonic jerks can be a seizure although many of us experience normal sleep myoclonus--or jerking of our extremities as we drift off to sleep.
Some people have intractable epilepsy or difficult to treat seizures. They have failed many medications but continue to have seizures. This might be the reason your person doesn't want the squad called. She may know that there is not much they can do for her and doesn't want to incur an additional expense for a ride to the hospital to hear so.
I don't know what this young lady has but I do know that epilepsy is often misunderstood. It is still a stigma so many people don't want to share that they have it and will go to great lengths to hide it or minimize it.
I appreciate you wanting to find out more information. The Epilepsy Foundation of America is a great resource for information and training.
I But out of curiosity, do you know how an MD would be able to differentiate the two, if there aren't any definitive tests to diagnose a pseudoseizure?
Before entering this conversation, it seemed to me that a pseudoseizure diagnosis was given mostly to appease a patient who was unwilling to accept "Nothing is wrong with you." The reason I thought this was because I have had several patients with pseudoseizure in their health history, who were clearly faking. And before anyone says I don't know and shouldn't assume...let me just say, I am referring to behavior such as coming out to the nurse's station, gently lying themselves on the ground, and then flailing around. Or finding out how often they could get Ativan, and then pressing their call light to tell the nurse they were having a seizure q4h on the dot.
It sounds as if in this case, pseudoseizure is being loosely used as a blanket diagnosis for something that clearly isn't epilepsy. What you are describing as laying down and flopping to get drugs is drug-seeking manipulation.
I wonder if noxious stimuli is applied, (such as a sternal rub or force to the nail bed) or an ammonia capsule used will the person stop the fake seizure? We never give Ativan or benzos for pseudoseizures so there is no gain to fake a seizure. If someone Laude down in the floor and told me they were going to have a seizure and they had no epilepsy diagnosis, I would calmly tell them to let me know when it's over. (Obviously if there was even a remote chance they had seizures, I would not do this!).
I don't know that there is a "test" to determine the difference between the two, but in your example, your patients have found the magic word and how to "fake" a seizure in order to get drugs. Pseudoseizures are the body's way of dealing with something the mind can't.
Actually, the person I am talking about is an adult, and she seems to have no family. Of course everyone has family, but you know what I mean: estranged from her parents, no partner, no children, and even her brother and sister live far away and aren't consistently in the picture. That's one of the things that made me suspect attention-seeking behavior in the first place. It does not seem like she has a great support system in place. She needs to be getting the love from somewhere, right? We are as good a source as any.
After doing some more due diligence (I admit that my first search was mostly limited to fake seizures, but now I've been looking at real ones too), I know that the spectrum of seizure disorders is pretty wide, and it includes many types of "strange behavior" that I wouldn't have seen as any kind of seizure before I posted this topic here. This particular student told me her seizures are tonic-clonic epilepsy, though. And because my grandson has the same type of seizures, I expected the same, or at least a similar presentation. Her quick mental recovery, coupled with protracted physical impairment (trembling, stiff limbs) threw me off.
I suppose you were trying to say that what I'm seeing in this person could very well be legitimate epilepsy? If so, thank you for letting me know. It has changed my outlook, and I'm sure it will change the way I handle the next seizure I witness, even if only subconsciously.
Specializes in Leadership, Psych, HomeCare, Amb. Care.
There is a distinct difference between "faking a seizure" a pseudoseizure, and epilepsy. Faking a seizure is something anyone can do. With a pseudoseizure, a person is not really faking it. A pseudoseizure is the body's response to a psychological stressor. It can look exactly like a seizure but if the person is placed on an EEG, it will be normal during the "seizure." The treatment for pseudoseizures is working with psychology/psychiatry to address and deal with the stressor.
Epilepsy is an electrical storm on the surface of the brain. Seizures can be focal or generalized and may look different from person to person depending on what part of the brain is affected. A seizure can start as a partial seizure and spread to a generalized seizure. There are no rules for what the seizure looks like or how long it should take to recover.
A person can have both pseudoseizures and epilepsy! It is important to give anyone the benefit of the doubt that appears to be having seizure like activity. Protect their head from injury. Never put anything in their mouth. Protect their airway by rolling them on their side. Time the event and note what the event looks like.
Like others have said, Tegretol can be given for several reasons. The spell could have been anything but I would err on the side of caution. If it lasted for longer than 5 minutes, I personally would call the squad unless there was a documented medical reason not to.
excelent post.
Its important for the OP to realize that there ~40 different types of seizures, ranging from absence seizures that may not even be noticed, to the classic grand mal/tonic-colonic.
it sounds like the organization really needs to address this issue. Yes, there are privacy laws, but when her illness affects the operation of the center, or is a safety concern, it is no longer private. Many people know their illnesses, and a person with frequent seizure activity is reasonable to not want to take a trip to the hospital each and every time. But, f her head is repeatedly banging against the floor...an ambulance is prudent.
sounds like her MD needs to provide safety guidelines.
Maybe the difference between your grandson's seizure presentation and the student's presentation is that the students primary medical condition is cerebral palsy, the protracted physical impairments you describe sound like cerebral palsy symptoms.
amoLucia
7,736 Posts
Forgot to add - One thing about the 'ambulance not needed' thing. Up to now, maybe all her 'seizures' have been mild??? She may be counting on that fact so as to avoid a trip to the hospital ER with possible admission. Maybe she really doesn't want to make a big thing out of her seizures. Great until a big one does happen ...