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Discussion

Interesting Seizure

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One of our patients (neuro) was talking, coherent, hx a fib s/p ablation and D/C of amiodarone, on a couple of psych meds and BP Rx, DM2, severely obese when all of a sudden he started shaking, (trunk, upper body) not tonic-clonic, did not lose his train of thought, become incontinent, or have any change in LOC. After a few seconds, maybe 15, 20 seconds, the shaking stopped. He says this was an anxiety attack. It happened 4 times within about 40 minutes.

Has anyone seen anything like this?

I guess I've only ever seen absence and grand mal. Oh, but a classmate in grade school used to throw her arm into the air and shriek before her seizures. I don't recall her having incontinence, tonic-clonic movements, airway issues, falling, or post-ictal state.

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    Sounds like it could be a myoclonic seizure. But if the patient thinks it was an anxiety attack, it might not have been a seizure at all. Without an EEG, you can't really conclusively say.

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    I had a patient who sounds pretty similar to this. He also called them anxiety seizures...he was also very aware of the fact that patients get Ativan when they have a seizure.

    They brought in a specialist, who diagnosed him with anxiety and "pseudo seizures," and his PRN order for Ativan was d/c'd.

    He was originally admitted due to DKA, but ended up staying in the hospital for a really long time waiting for placement in assisted living.

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    psueo-seizures

    Agree with post above -- EEG is the definitive diagnostic tool.

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    Highly unlikely to have a seizure without any interruption in normal cognitive process... e.g. continue to talk to you coherently. This even happens with petit mal, temporal (absence) seizures.

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    I agree; the pt said it was an anxiety attack...so it was an "interesting" anxiety attack, not an "interesting" seizure. :)

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    I've actually seen this several times with increases in Haldol. The exact reason was unknown, but would always go away with a reduction in Haldol. I would believe your patient! These meds can do so many strange things.

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    • Expert
    I agree; the pt said it was an anxiety attack...so it was an "interesting" anxiety attack, not an "interesting" seizure. :)

    I'm not quite ready to decide it was drug-seeking, as someone above suggested, or truly just anxiety. EEG recommendation sounds correct to actually diagnose. I also think that precipitous DC of cardiac meds after ablation could have played some role. Will speak to a few pharmacists.

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    • Author
    • Expert
    I've actually seen this several times with increases in Haldol. The exact reason was unknown, but would always go away with a reduction in Haldol. I would believe your patient! These meds can do so many strange things.

    Aha! I will review his psych meds and other meds, too. I really think meds can have so many effects on individual patients that are different from patient to patient. I just need to figure this out for my own education, as I've never seen anything like that before and pt said he didn't feel anxious, just that this was an anxiety attack.

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    • Author
    • Expert
    Highly unlikely to have a seizure without any interruption in normal cognitive process... e.g. continue to talk to you coherently. This even happens with petit mal, temporal (absence) seizures.

    One of our neurologists diagnosed seizures in a patient with the following: no LOC but drowsy, sleepy, able to function, pt felt generalized weakness but had no neuro deficits. Was able to keep moving, working, although just had great drowsiness. The event passed without treatment in about 1 - 2 hours. I forget what type of seizure this was called. Anybody know? I thought they might have been TIA's but they don't really fit the criteria for that as far as I know.

    They occurred about once every few months. Glucose was normal, per patient. Some neuro degenerative process maybe?

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    I'm not quite ready to decide it was drug-seeking as someone above suggested, or truly just anxiety. EEG recommendation sounds correct to actually diagnose. I also think that precipitous DC of cardiac meds after ablation could have played some role. Will speak to a few pharmacists.[/quote']

    My quote did not have anything to do with drug seeking; my point is if the pt has been diagnosed with anxiety, it could be just that.

    One of the things I do as a nurse is to not determine "drug seeking"; anyone who has a past history of drug use has a chronic condition and when dealing with other conditions, you have to thoroughly assess and balance whatever their principal problem is with the co-morbidities.

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