Pseudo Seizures

canigraduate · May 6, 2016

I've had a few pseudo-seizure patients. The easiest way for me to determine if they are true seizures, without harming the patient, is splashing some water in the face. The pseudo-seizure patients always flinch.

The pseudo-seizure patients I have had have all been women with psychiatric backgrounds. Don't know if that's a cause or a correlation, but it's not something that can be fixed overnight in OBS. It gets old having the repeat offenders come back for seizures, then we turf them the next morning. The patients that I've had with this, personally, have been very manipulative. One told me, "Look at my eye! See how it's twitching! I need IV Ativan!" I told her that IV ativan doesn't help with eye twitches and she should probably eat a banana. She then sic'ed the drama llama on me. Fun night.

SnowyJ, RN · May 6, 2016

I do have a student with absence seizures. Sounds a lot like what you describe. The teacher realized she would "daydream/stare" a lot then snap out of it. Neuro did tests and made diagnosis. No meds.

Makes you wonder how many kids with ADD (Inattentive) may be having absence seizures...The brain is such a mystery.

Flare, ASN, BSN · May 6, 2016

i'm familiar with absence seizures - i have just never seen them go on for such extended periods of time before this child.

ContraryMary · May 6, 2016

As a first year high school nurse I don't have enough energy to comment on this. :dead: What I will say is that both of my kids with this (hopefully) graduate this year!!

OldDude · May 6, 2016

As a first year high school nurse I don't have enough energy to comment on this. What I will say is that both of my kids with this (hopefully) graduate this year!!

Mary, you're so Contrary...I know I know!! I'm not the first to say that but I could help myself :)

ContraryMary · May 6, 2016

Oh, you've caught me on a good day!

blackribbon · May 6, 2016

How completely uncompassionate many of these responses are. Psychogenic seizures are seizures that are not related to the neurological systems...so they have normal brain waves on a ECG. That does not mean the patient is "faking" it. They are believed to be a psych diagnosis and caused by extreme anxiety or PTSD or other psychological origins. The patient is NOT in control. We still treat them by providing a safe environment and drugs like ativan but they can not be controlled or prevented using anti-seizure meds. To say it is "faking" it, is the same as saying that all psych diagnoses are "fake" and should be disregarded. Last I looked, our brains and our psychological health is still part of total health.

MrNurse(x2), ADN · May 6, 2016

How completely uncompassionate many of these responses are. .

I totally admitted it. Please be aware of the context in which you are responding. We are dealing with kids, which, as my kid's counselor agreed, are much more "fragile" than just 2 generations ago. Although there may be traumatic sources, it has been my experience here in the land of abundance to be a cry for attention, normally involving MANY more people than the child's parents. This is my worldview. I would keep them safe, monitored, and treated with respect, but that doesn't change the root of what I would see in my environment. I have a "Tourette's" that leans into a microphone to amplify her tics, be sent to my office with tics that have NEVER lasted more than 2 minutes with therapeutic boredom, etc. I have given NAMI presentations to my middle schoolers to reduce the stigma of mental illness, but I believe many adolescent issues are really relational issues, not organic, at least in my environment. This is not a psych forum, we encounter all aspects of health and issues, this is our nurse's lounge to discuss our hard cases, as we don't have coworkers to bounce things off of. You're welcome here, but please keep the forum context in mind.

blackribbon · May 6, 2016

Psychogenic seizures are not neurological but they are REAL. They have a psychiatric origin and are induced by severe anxiety or PTSD or such. The patient is not in control so they are not "fake". They are treated with some of the same medications like ativan but do not respond to anti-seizure medications because they are not neurological. They will have normal ECG waves even during the seizure and the seizure presents with small variations from neurological seizures...but honestly, they mostly look the same. We provide a safe environment for both and they both require treatment...just the psychogenic ones are treated in the psych department. To say they are "fake" is to disregard every other psych diagnosis as "not real" which is a really sad part of so many medical professionals viewpoints. Anxiety alone can mimic so many medical conditions and it should be addressed as part of a patients total health. Also, it has been shown that many people can have both types of seizures so be careful before you make too many assumptions. They are often referred to as "seizure-like" activity...but I believe that every seizure is called that unless it is actually positively diagnosed.

Don't call an ambulance for ANY seizure unless the person has no history of seizures, it is part of multiple seizures, it is accident induced, or it goes on longer than a five minutes....just provide a safe environment for them to seize.

NOTE: Sorry, some of this is a repetition from a previous post that I thought my computer erased and didn't post.)

blackribbon · May 6, 2016

Try to imitate a seizure and keep it up for 5 minutes which is how long a normal seizure lasts. How would a kid even know what to do? They are real but have a psychological origin.

blackribbon · May 6, 2016

I totally admitted it. Please be aware of the context in which you are responding. We are dealing with kids, which, as my kid's counselor agreed, are much more "fragile" than just 2 generations ago. Although there may be traumatic sources, it has been my experience here in the land of abundance to be a cry for attention, normally involving MANY more people than the child's parents. This is my worldview. I would keep them safe, monitored, and treated with respect, but that doesn't change the root of what I would see in my environment. I have a "Tourette's" that leans into a microphone to amplify her tics, be sent to my office with tics that have NEVER lasted more than 2 minutes with therapeutic boredom, etc. I have given NAMI presentations to my middle schoolers to reduce the stigma of mental illness, but I believe many adolescent issues are really relational issues, not organic, at least in my environment. This is not a psych forum, we encounter all aspects of health and issues, this is our nurse's lounge to discuss our hard cases, as we don't have coworkers to bounce things off of. You're welcome here, but please keep the forum context in mind.

This is still a NURSE's forum...and this is a real health care condition that isn't just a "hard case" but requires a little bit of compassion and a bit of medical research. The question was asking if this was a "fake" condition. It is real. And how on earth is a psych diagnosis not part of every person's total health? I actually work on a med/surg unit and am appalled by the number of nurses who don't "do" psychiatric diagnoses...when to treat a person appropriately requires all health related diagnoses. For example, what good does it do to treat malnutrition if you don't address the psychological component that caused the eating disorder in the first place? Telling a child having a psychogentic seizure to "cut that out" won't treat the psychological cause...nor will ignoring it. It is not in the person's control. The best you can do is to address the anxiety that may have caused it to happen.

Keepstanding, ASN, RN · May 6, 2016

I don't recall anyone here lacking compassion. I don't recall anyone here not doing their best to protect the "seizing" student. Student safety is our first priority. THAT'S WHAT WE DO !! Some of you need to get off of your high horse a bit and work a day in our shoes.

1000 kids. One Nurse. No backup. No meds. No Care Plan. Parents who can't be reached. Parents who don't give a crap. Try it !!