Pseudo-seizures

Nurses General Nursing

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I am a new nurse still orienting to the ICU, so yes, I am very green. I had my first experience with what was originally thought to be grand mal seizures but was soon suspected to be pseudo-seizures. The whole experience was mind boggling to me. The seizures were whole body spasmodic lasting for less than 30 seconds, no loss of bowel functions, no post-ictal (sp?), completely coherent within minutes, some expiratory wheezing afterwards, eyes responded to stimulus, and always occurred soon after the patient was emotionally upset. She had a seizure while she sitting in an upright chair and amazingly did not even end up on the floor or get hurt. I might also add that the seizures NEVER occurred as long as someone was in the room with her and giving them her full attention.

The pt. was completely noncompliant with the nursing staff, refusing to stay in bed (even though we explained REPEATEDLY the danger of being up with the frequency of the seizures), tearing leads off, even attempting to walk off the floor half naked to drive herself home. She went ballistic when she overhead the possibility of restraints. She swung from being completely happy, to being anxious, to crying, to apologizing, to screaming, etc.

As the shift went on more and more information came out - she was a frequent flyer and many of the staff remembered her from years prior at different hospitals. It was very difficult to decipher what of her history was true or not as she has changed doctors quite often.

She was currently on Dilantin, and surprisingly enough, NO psych meds. We ended up having someone come from another floor to act as a sitter and she seemed as happy as a pig in mud then. I was not her primary nurse and an still wondering why a psych consult was not ordered for her.

I have no psych experience and am completely naive in that way but I just couldn't believe someone would put themselves through the physical and emotional hell she was going through just for attention. I guess my question is has any had any experience with this? What would you have done in this situation?

Pseudoseizures, aka Psychogenic Nonepileptic Seizures

http://www.emedicine.com/NEURO/topic403.htm

leslie

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emedicine says:

"Unlike epileptic seizures, PNES (psychogenic nonepileptic seizures or pseudoseizures) do not result from an abnormal electrical discharge from the brain; they are a physical manifestation of a psychological disturbance. They are a type of conversion disorder or, more broadly, a type of somatoform disorder, and they are usually involuntary. PNES can also result from voluntary faking (feigning), as in malingering and factitious disorder."

It can be faking, as noted in some stories above. However, often it is a mental disease, like depression, etc. If someone has a panic attack, do you get upset and say they are just "faking it to get attention or get meds?"

Stress gives me a stomachache, and my stomach really hurts. Medicine even helps it. I would be really upset to know other nurses were saying I was faking it. Many people get headaches with no organic source. Are they faking it?

Pseudoseizures occur when a person can't handle the stress they are under, and the seizure is their coping mechanism. It's rather dysfunctional, but that's why it's called a conversion disorder.

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Specializes in Cardiac.

Pseudoseizures occur when a person can't handle the stress they are under, and the seizure is their coping mechanism. .

And somehow psudoseizures stop when the pts finds out that uncomfortable tests need to be performed, that they don't get the attention that they want, or that they don't get the privileges that they want (like visitors).

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Specializes in ICU/Critical Care.

"takes a bow" I mentioned conversion disorder early on in the thread..woo me...lol just kidding. Yes, I'm very careful not to label someone who really is having seizures as faking them. I know the difference. I wouldn't label a patient faking seizures if I didn't have their history. My patient that I described was diagnosed with conversion disorder. She did a lot of other things though to have unnecessary medical procedures done. Like on day shift, the nurse had to straight cath her instead of making her use the commode and then while the nurse was on break, she feigned respiratory distress and almost got intubated even though her ABGs were normal. She started her feigning as soon as anyone in a white coat or a nurse entered the room.

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Specializes in Medical/Surgical.
emedicine says:

"Unlike epileptic seizures, PNES (psychogenic nonepileptic seizures or pseudoseizures) do not result from an abnormal electrical discharge from the brain; they are a physical manifestation of a psychological disturbance. They are a type of conversion disorder or, more broadly, a type of somatoform disorder, and they are usually involuntary. PNES can also result from voluntary faking (feigning), as in malingering and factitious disorder."

quote]

:yeahthat:

I had a visitor once who was sitting with her friend (the patient). The patient had to be put in Buck's traction. As we applied the traction, the patient let out a little moan and the visitor went stiff as a board, started making a loud snoring noise, and shaking violently. We surrounded her, of course, and when she came around, began grilling her with questions regarding her medical history. She said that this has happened to her several times and that it was always related to somone else being in pain. ??? I will say that at first, I passed her off as a little "odd". But then I started researching and found that it is entirely plausible for a stressfull situation to cause a "psychosomatic" seizure. Her trigger was the discomfort of those she cared about. It stressed her out psychologically and triggered an actual physical response in the form of a seizure.

This just struck me as interesting since the original poster stated that the patients siezure activity was almost always after a stressful situation.

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Specializes in ER, TRAUMA, MED-SURG.
"At 1200, I need my dilaudid. At 1210 I will require my phenergan IV push. At 1220 I need my valium. At 1230 I will require zofran. At 1240 I'd like my oxy pill. At 1250 I'll state my pain at a five, walk around my room and straighten things up, and ask for a sandwich. At 0100 I'll need dilaudid again....."

Rinse and repeat

Oh, I love it!!! I love it!! One part I wanted to slip in there...

"...At 0100 I'll need dilaudid again... " Night nurse hears a strange beeping noise down the hall and goes down to investigate the noise. Outside the door to 'Ms. I want my meds' door, she hears noise very loud and opens door. Inside is 'Ms. I want my meds' in her bed, eyes closed, mouth open, snoring. The noise is the patients ALARM CLOCK that started beeping because she set it to go off just before time for her next dose of Dilaudid."

I don't mean to sound insensitive, but setting your alarm when it is close to time for a next dose of meds?!

Anne, RNC :banghead::banghead::banghead:

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Specializes in ER/Trauma.

I usually order a STAT Porcelain level ;)

cheers,

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Specializes in ER/ICU/Flight.

an MD told me one time that a seizure and an intact reflex are mutually exclusive events. his advice was to test a corneal reflex, if the pt was apparently having a tonic-clinc sz and a present reflex then you could safely conclude the pt was faking.

i agree with posters who've said it's not our place to determine whether someone's faking or not, but i also agree stongly with everyone who's said that these pts take time and energy away from others who really need care. and if someone's able to carry on a conversation mid-sz, or miraculously "recovers" at the mention of an unpleasant procedure...then i believe it's safe to say they weren't having a true sz.

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Specializes in Acute Care.
an MD told me one time that a seizure and an intact reflex are mutually exclusive events. his advice was to test a corneal reflex, if the pt was apparently having a tonic-clinc sz and a present reflex then you could safely conclude the pt was faking.

i agree with posters who've said it's not our place to determine whether someone's faking or not, but i also agree stongly with everyone who's said that these pts take time and energy away from others who really need care. and if someone's able to carry on a conversation mid-sz, or miraculously "recovers" at the mention of an unpleasant procedure...then i believe it's safe to say they weren't having a true sz.

Plus, as nurses we would have to call the MD and state pt had "seizure like activity" but explain it didnt follow normal seizures, e.g. no post ictal state, rapid return to normal behaviors, etc.

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Specializes in Medical/Surgical.

'Ms. I want my meds' in her bed, eyes closed, mouth open, snoring. The noise is the patients ALARM CLOCK that started beeping because she set it to go off just before time for her next dose of Dilaudid."

I don't mean to sound insensitive, but setting your alarm when it is close to time for a next dose of meds?!

Anne, RNC :banghead::banghead::banghead:

I feel ya! This is actually a common occurance on my post-surgical floor. RIDICULOUS!!!:grn:

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Specializes in ER, TRAUMA, MED-SURG.
I feel ya! This is actually a common occurance on my post-surgical floor. RIDICULOUS!!!:grn:

And I would be mortified if I was that patient!!!!!!!

Anne,RNC

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I am an LPN and was diagnosed with generalized seizure disorder in October of this year, after having 3 grand-mal seizures and falling and busting my head that caused a severe concussion and a small bleed....I went 3 months without having a seizure but in december I had several tonic-clonic looking seizures without losing bowel and bladder control, I then had some Jan 18th and several more times in Jan..I was confused after. But not for that Long. I had a doctor diagnose me with pseudo-seizures also! This is very confusing to me because I am definately not faking these seizures or want to have them at all. I imagine the stress from the seizure diagnosis and the recovery after my head injury caused my pseudo-seizures! I had them when I was alone also! It is real and scary, My husband who also works in healthcare will give me a shot of ativan if they continue and within about 1 hour they subside. I don't know what the difference is and how to tell if I am having regular seizures or pseudo seizures? with all my seizures I have shaking all over muscle contraction, some drooling or foaming at the mouth, but no loss of bowel or bladder! There maybe some people who fake this crap, but not me and I find it very offensive to hear nurses not give good care even to someone who may be faking!!!! They are still a patient and obviously need some care and help. I have been in counseling for 1 month, I went off of my topamax, I am now on Klonopin and Keppra and I still have seizures about every two weeks!!!! Before all of this I was a healthy 30 year old working in a job I love and caring for my two great girls. I would love to be able to work again!

Heather

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