Pseudo Seizures

OldDude · May 7, 2016

Bolding is mine. I'm next to verclempt that it seems you're making fun of psychiatric issues.

This is a school nurse forum. We're talking about kids. Go away.

Farawyn · May 7, 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.

Kids can fake almost anything.

Farawyn · May 7, 2016

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.

We do. I do. They do. We address anxiety all day long. We refer. We hug. We medicate.

We also deal with grand mal, petite mal and diagnosed seizure disorders. We recommend neuro consults We attend 504s.

Don't even suggest that we don't do our jobs. We follow through 100% of the time.

Even when we KNOW your kid is faking? We follow through. We have to.

We are venting and supporting each other.

SheriffLauren · May 7, 2016

I had a student that did this at the beginning of the school year. Dr. could find no reason for it. Through a little research, I found what is called a Psychogenic Seizure that could be brought on by anxiety. The doctor never diagnosed this, but we treat any episode as we would a seizure.

On the psych units I've only seen a pseudo seizure caused the pt was highly anxious

jadelpn, LPN, EMT-B · May 7, 2016

I thought about this last night. I Had a student in my multiple disabled room last year who has since moved to another district - so i can no longer reference the chart, but I believe after work up upon work up he was ultimately diagnosed with pseudo seizure. Now, i may be wrong - i am dealing with my end of year brain to think about a student that my brain decided i can start purging facts on. So that exact detail is hazy - but i can tell you that he was on daily meds - depakote or something, which i thought was odd, because his parents were insistent that he did not have a seizure disorder despite his shiny new seizure action plan and tendency to become unresponsive, staring gaze, etc... these periods could easily go longer than 5 minutes. This child did not have the mental capacity to think up faking a seizure. So if it wasn't a seizure, then the doctors needed to keep digging because something abnormal was happening and there was some sort of abnormal activity occurring.

In my earlier years, I can recall Depakote being used as a mood stabilizer. It was when I got into acute care that I realized it was a seizure medication as well.

Pseudo is just that--false or having the appearance of.

That a kid is using this as a method of processing--that is an issue that needs to be explored by psych. Trauma based (and yes, some may not adhere to that thought process) it is worth it for the nurse to at least use resources to rule that out. Not to mention the kid, who may be waving a huge red flag regarding what is happening to them.

When someone experiences trauma, it has been my train of thought that there's seemingly some links between that and anxiety disorders, fibromyalgia, pseudo seizures, oppositional defiance disorders and the like. PTSD can take many forms, and come out in various ways.

Breaks my heart that I am not sure how a child would "learn" this behavior as an acting out, or to process trauma. I always have said your can be as screwed up (

SnowyJ, RN · May 7, 2016

Thank you so much for saying this.
I am trying really hard to keep my response as polite as possible, but shame on anyone who declares "pseudoseizure" a ploy for attention. Epilepsy comes in SOOOOO many different forms and will not always reliably show up on an EEG. The person being called a faker is WAY more frustrated than you ever will be with "wasting" your time.
I was in status epilepticus for 6 days before someone actually paid attention to me. I was blown off completely by providers I'd seen for years. But because MY type of epilepsy doesn't look like REAL! epilepsy, I was ignored. My EEG didn't show epileptiform activity throughout most of it. (This was months after the epilepticus, because I had to beg for a referral.) Thank god it did for the small time it did. I would have moved on from that, still getting blown off. I'd be labeled an "attention seeker".
I'm already in a horrible mood today, so please take some of my disgust as being part of that. Even in my best mood, though, the assumptions and judgment displayed here would still bother me.

While I sympathize greatly with what you went through, please keep in mind that as school nurses, we must be able to assess our students fully and to the best of our ability. There are DISTINCT differences between epileptic seizures and psychologically induced movements that mimic seizures. To the UNTRAINED eye, yes, it may look like a seizure. To a medical professional with good assessment skills, we should be able to at the very least know the difference. To ignore what we are assessing and observing would be foolhardy. YES, I realize that there are extreme emotional contributing factors that can manifest in seizure-like activity. This does not mean a person is "faking," but it decidedly does not meet the criteria for SEIZURE.

One of the hardest parts of my job is being able to accurately assess what I am seeing, hearing and sensing in my students. I am not perfect. But to throw my experience and ability to assess out the window makes no sense. I am not willing to manufacture findings that do not exist.

In the case of my student who presented with seizure like activity. I was very concerned for his mental health status. He followed up with his Psychiatrist. I did not dismiss what happened, but I am not going to call it what it is not. Not in his case, and not in any other case where the findings to not mesh with a potential problem.

SnowyJ, RN · May 7, 2016

Kids can fake almost anything.

Yes, yes they can.....

OldDude · May 7, 2016

Yes, yes they can.....

And, just to stir the Schlitz, I'm gonna throw this out. School Nurses will immediately understand what I'm saying. Many, many, symptoms arise from the kid "listening" to parent/physician conversations regarding what side affects and other conditions to watch out for; "Be sure and let me know if - fill in the blank." For example, the kinder kid who was started on Quillivant coming into my clinic telling me, "I'm misoriented. I need to let the doctor know."

OldDude · May 7, 2016

Jade...Depakote is still prescribed for kids, with no seizure association, as a mood stabilizer. And it breaks my heart also to see some of the awful home environments some kids are in. How they are used as bargaining chips between divorced parents, left alone to fend for themselves, or kids forced to take care of their kid siblings, and on and on, so the way these anxietys, emotional/physical trauma, and fear manifest in these poor children is, at best, unpredictable. Unfortunately we only recognize the most extreme manifestation of their emotional turmoil but it's just the tip of the iceberg. We try to help as many as we can.As School Nurses for your children, and our children, one of our responsibilities is assessment and intervention...kids manifesting with seizure appearance will certainly fall into this category. It's up to us to triage the situations and act accordingly. We take this seriously, very seriously.

Farawyn · May 7, 2016

While I sympathize greatly with what you went through, please keep in mind that as school nurses, we must be able to assess our students fully and to the best of our ability. There are DISTINCT differences between epileptic seizures and psychologically induced movements that mimic seizures. To the UNTRAINED eye, yes, it may look like a seizure. To a medical professional with good assessment skills, we should be able to at the very least know the difference. To ignore what we are assessing and observing would be foolhardy. YES, I realize that there are extreme emotional contributing factors that can manifest in seizure-like activity. This does not mean a person is "faking," but it decidedly does not meet the criteria for SEIZURE.
One of the hardest parts of my job is being able to accurately assess what I am seeing, hearing and sensing in my students. I am not perfect. But to throw my experience and ability to assess out the window makes no sense. I am not willing to manufacture findings that do not exist.
In the case of my student who presented with seizure like activity. I was very concerned for his mental health status. He followed up with his Psychiatrist. I did not dismiss what happened, but I am not going to call it what it is not. Not in his case, and not in any other case where the findings to not mesh with a potential problem.

:inlove:

NutmeggeRN, BSN · May 9, 2016

I work adult acute care, so feel free to take this or not. In my last patient with pseudoseizures, they were more related to the psych diagnoses than anything neurological. Maybe if you can get a neuro to look at the kid and explicitly suggest a psych evaluation, that might grease the wheels a bit?

Get Neuro to look at the kid? Please define that?

We are alone, often a student census of 500-1000, we may not be here full time. IF we can get the parent to follow up, we do! They may or may not. If the child is in danger then it is a DCYF call. If it is an undiagnosed condition or lasts more than 5 minutes it is a 911 call.

We can barely get the parents to bring kids to a regular MD sometime, let alone neuro.

ana010 · May 9, 2016

My experience with pseudoseizures in middle school students was only 2, thankfully.

The first was a new student I did not know. Student was resting on cot, then did not respond to questions or when I rubbed her arm. This lasted greater than 5 minutes. Called 911, called grandmother and shared that student wouldn't respond, but like other posters have mentioned, when hand was lifted over her head it never hit her head. I realize that is not a fool proof test, but in a school setting it's about all you can do to check. I did treat her as if she were having a seizure, but I have seen seizures and this did not look like one. Grandmother shared she had recently been discharged from inpatient psych facility.

Grandmother had student medically evaluated. When EEG changes were not seen, the student was further evaluated and readmitted into a psych facility.

Second student's mother came into my office, orders in hand for her pseudo seizures. Student had only experienced at home at this point. But the episodes quickly began happening in the school setting. I did a health care plan and had mom sign a release of info form. Faxed that to her neuro doc and had multiple conversations with neuro nurse for guidance in classroom setting. This nurse said the majority of patients her clinic sees have pseudo seizures. How sad it that? Also stated, in this student's case, the belief was there was an attention seeking component to it, mother agreed, as well. Nurse recommended seating at the back of the classroom, out of line of site of other students. I was still called for every episode, but encouraged teachers to continue teaching and not allow class attention to be placed on this student. I would wheel her out and it would end within a minute.

This was exhausting, but at least it was the last 6 weeks of school. This child has since moved to another school, so I am not certain if her therapy she was in at the time helped or not.