Pseudoseizures?

fiestynurse · Feb 1, 2004

In reality, people who have pseudoseizures are often not aware of the cause or able to consciously control the events. They are not "faking it.' They are often experiencing severe emotional stress, and their brain is finding a way to release it, to communicate feelings which they do not feel safe enough or possess the skills to put into words. Your right in saying that this is an involuntary stress reaction.

Your nurse friend does need to work with a Psychiatrist to identify the emotional triggers and there are also medications that can help. She needs your support more than ever right now.

Correctional nurses can probably give you information on this topic. Inmates are notorious for having these pseudoseizures because of their inability to cope with the stress of their incarceration.

NurseJacqui · Feb 1, 2004

But what I wonder is if this was really a pseudoseizure or was she just faking it? Like maybe she has Munchausen's or something? Because over the years the girl has gone to the ER for a variety of complaints all totally unrelated. I also know that she has an affinity for presription drugs. And sometimes she will be out of work " sick" for weeks at a time but yet when she comes back she always looks healthy. Like you know how people get that " sick" look to them? If I get a cold I look like I fell out of a tornado, yet she looks as good as new. Its like I want to be supportive but now I don't know if I can trust her. And after this incident, I don't know if she is going to come back. Its all so disturbing. :confused:

huckfinn · Feb 1, 2004

Keep your eyes open and be careful. I would worry about getting sucked into her "syndrome" as a co-dependent.

fiestynurse · Feb 1, 2004

You can be supportive without being "co-dependent." She needs professional help and as huckfinn has said you don't want to get sucked into her emotional issues. It sounds like she has involved parents, who have probably dealt with similar incidences with her.

Just curious as to how you found out about all this confidential health care information regarding a fellow worker? I would not want to show my face back at work either, if I were her.

NurseJacqui · Feb 1, 2004

Its funny because we went to college together and now looking back at all the medical problems she had, I am wondering if they ever even existed. Like she said she was in ICU over the summer with a chest tube because her lung kept collapsing for no reason. Yet she looked great when she came back and she was bumming cigarettes off of everyone, yet she was taking morphine at home because she said it hurt her to take deep breaths. She certainly inhaled that cigarette with no problem. I kind of hope she doesn't come back because she will be looking to me for support and I don't know if I can give it. :confused:

NurseJacqui · Feb 1, 2004

Well, we are both ER nurses and she decided to fake her seizures while at work so she became an ER pt. I was her nurse. That's how I know. If she has a problem, I want to be supportive without feeding into it and giving her too much attention. I think she needs help.

Toadly · Feb 1, 2004

Though "maybe" pseudo-seizures are the case; fully plausible.

However if truly prognosis of pseudo-seizures via one surface EEG test result, considering the percentage of inaccuracies documented (and not) this is akin to diagnosis via pin-the-DX-on-the-patient, blindfold and all.

Examples:

Following is from:

Fujimoto S, Mizuno K, Takasaka Y, Shibata H, Kanayama M, Ishikawa T.

Department of Central Clinical Laboratories, Nagoya City University Hospital.

We analyzed the ictal electroencephalographies (EEGs) in 75 seizures of 73 patients...
...Because half of the patients with pseudoseizures also had epilepsy, their ictal EEG examinations were very useful.

"A Remarkable Position to Be In"

Dr. Anthony Ritaccio

NYU Comprehensive Epilepsy Center, New York

{quote]...Glimpses of the difficulties faced by neurologists of old are still afforded to us today by those cases-usually involving seizures in the part of the brain just behind the eyes, the prefrontal cortex-wherein the EEG does not show any sign of seizure activity.

From this site:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=88319291

...Overall, among the 87 simple partial seizures, only 18 (21%) revealed ictal EEG changes. Thus, a normal EEG is common during simple partial seizures and does not exclude the diagnosis.

PMID: 3137487 [PubMed - indexed for MEDLINE]

Following is from:

Electroencephalographic studies of simple partial seizures with subdural electrode recordings.

Devinsky O, Sato S, Kufta CV, Ito B, Rose DF, Theodore WH, Porter RJ.

Division of Intramural Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892.

We used subdural electrodes to study the EEG features of simple partial seizures in 7 patients. We detected epileptiform discharges in 61 of 68 subdurally recorded simple partial seizures compared with 6 of 55 simple partial seizures recorded with scalp electrodes (p less than 0.0001). ...

This topic is also discussed at greater length with (in my opinion) far too many assumptions though addressed on page ten (some redundant); thread "faking it".

Possibly one of the most common comments heard by a person with Epilepsy or seizure disorder:

"but you look fine".

--Then put a band aid on my head.

I agree she needs help, the "why" I do not see as answered yet.

All my best to all

fiestynurse · Feb 1, 2004

Toadly - that's true, maybe the neurologist was wrong? Numerous patients labeled with pseudoseizures actually turn out to have real though atypical seizures on depth telemetry and real seizures commonly co-exist in patients with pseudoseizures. However, given her history it's probably an accurate assessment.

TerraRN - If she contacts you for support, maybe you should just be honest with her about your concerns and the fact that you are having a hard time with this.

Tweety, BSN, RN · Feb 1, 2004

I don't have time to read every post right now. But to say she's "faking it" is a bit harsh. When a person is depressed or schizophrenic would you say they are "faking" it.

It's a genuine pysch. problem that needs attention same as any other pysch. illness.

I've had a neurologist say that a lot of these people were abused in their childhood.

It's not an exact science.

This is personal information and a violation if HIPPA btw for you to know, unless she told you herself. I hope the staff taking care of her aren't gossiping about her. :)

fiestynurse · Feb 2, 2004

I agree Tweety - I don't like the fact that she's being told that she is "faking it." These "seizures" are very real to her. They have actually thrown around the idea of labeling the pseudoseizure syndrome something else.

Tweety, BSN, RN · Feb 3, 2004

Originally posted by fiestynurse
I agree Tweety - I don't like the fact that she's being told that she is "faking it." These "seizures" are very real to her. They have actually thrown around the idea of labeling the pseudoseizure syndrome something else.

Especially the idea that "she decided to fake a seizure" while at work.

There's a difference between a person who says "gee, I want attention, I want to get out of work...I know...I'll fake a seizure", that a person with the physchiatric illness "pseudoseizure". That person usually has no conscious control over the "seizures" at all. This person didn't "decide to have a seizure" while working.

There was another thread on another board about this, it's been ressurrected by a person with a seizure disorder. In that thread I argued this point over and over and have no energy for it. I'm a bit dismayed at the number of nurses who can't understand that it's a physchiatric illness and not just an attention seeking faker. Oh well.

This person needs, compassion, understanding and profressional attention. Not judgement because she choose to fake an illness.

End of rant. :)