Seizures Real vs Fake

What Members Are Saying (AI-Generated Summary)

Members are discussing methods and experiences related to identifying fake seizures in inmates or patients. Some users share creative techniques, such as using ammonia inhalants or concrete therapy, to expose malingerers, while others emphasize the importance of not passing judgment on individuals with real seizure disorders. There is also a discussion about the challenges of distinguishing between fake and real seizures, with some users sharing personal experiences with epilepsy.

There was a patient/IM that had a possible seizure and the staff that responded were claiming that it was fake because she was alert and oriented.

How do you handle this situation, and how do you know the difference between real vs fake seizures?

I know there are different kinds of seizures. I am new to the jail population of patients and am trying to be safe with the real seizures vs the manipulators.

\ said:
the first thing I check is pupillary response.....pupils will generally be dilated and/or sluggish to respond to light. There is almost always nystagmus with the dilated pupils. As soon as they stop jerking I generally start asking questions as if they are awake when I suspect faux seizures.....like do you take seizure meds, what med, when was the last dose, how long have you had seizures, when was your last drug level, was it low, etc. The fakers generally end up answering all the questions accurately, albeit with some drama. After 32 years of ER nursing I can say I've never seen anyone wake up from a seizure and be able to answer those type of questions.

I would like to start this post by saying in no way am I trying to engage in an argument. I just want to to enlighten everyone about my side of the story.I've had epilepsy all my life and I can answer questions after seizures. I use words incorrectly I'm told but I can answer questions accurately. Nurses and doctors claimed I faked seizures as a child. until I was diagnosed after sleep study I actually thought I was crazy. I urge everyone to beware of passing judgements. Seizures are not well understood. They are scary and confusing for the patient.I'm a nurse at a prison and I do see fake seizures. I see real seizures that are deemed "fake" because they are not textbook. News flash not everyone will react the same.

Specializes in Pediatrics, Correctional.

I have been at my facility for 7 1/2 years. I have only had (1) real seizure!!!!!! What does that tell ya? I like the sternum rub to the chest.....that seems to get them. I use to use the ammonia caps, but my supervisor stopped any of us, due to someone might be allergic to ammonia! But I liked the advise of the ink pen lid!!!!!!

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

The jail I worked in had only metal or concrete surfaces, so real seizures always involved blood. If the person didn't bite his tongue, it was pretty hard not to hit his head on something during the fall. So bloodlessness was always a first clue. Being able to converse while "seizing" was pretty telling, too.

Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Mandiee said:
I would like to start this post by saying in no way am i trying to engage in an argument. i just want to to enlighten everyone about my side of the story.I've had epilepsy all my life and i can answer questions after seizures. I use words incorrectly I'm told but I can answer questions accurately. Nurses and doctors claimed I faked seizures as a child. until I was diagnosed after sleep study I actually thought I was crazy. I urge everyone to beware of passing judgements. Seizures are not well understood. They are scary and confusing for the patient.I'm a nurse at a prison and i do see fake seizures. I see real seizures that are deemed "fake" because they are not textbook. News flash not everyone will react the same.

I have epilepsy too. But after working in corrections & psych I can smell someone faking a seizure. That's also why we check & double check to make sure it's not a real seizure. But it's super easy to tell when someone's faking it. It usually involves talking about "Oh if I don't get this or that" or someone who just wants attention.

Specializes in Pediatrics, Correctional.

It is kinda of funny that we are talking about all of this........low and behold I got one in last nite that is trying his darnest to have a seizure.....keep in mind he does have real seizures according to his medical records from the hospital. But he is an ass and has he never been in our facility before......but he is demanding and wants what he wants when he wants it.....last nite he to the booking officers he was hungry and to get him some G-- D---n food now!!!!!! Then when they did get him a sandwich....he got to cussing some more stating he doesn't eat white bread b/c he is diabetic!!!!! I advised him to take the meat off and eat the meat only! Well that went over like a fart in church! Oh well, don't come to jail then you can eat what you want!!!!!! And of course he was trying his best to have a seizure (fake).....He was hollerying like a hurt animal and moving his arms up and down! Well your breathing, you didn't **** on yourself, your not foaming or drooling, your not thrashing around......I guess that was a new kind of seizure!!!!!

Specializes in ortho, hospice volunteer, psych,.

The amount of ignorance demonstrated in this thread is absolutely appalling to me. Contrary to popular belief, one does not have to lose consciousness, flail around, bite one's tongue, etc. to have had a legitimate seizure.

How do I know that?

It's very very simple. I have epilepsy as the result of having had several congenital aneurysms. Two of them ruptured when I was a baby and I had a massive CVA that resulted in the seizure disorder. Because I was so young, I recovered virtually completely, except for the complex partial seizures. Meds controlled them entirely until decades later when another aneurysm ruptured. My meds were changed and adjusted and I am almost completely seizure free. Triggers now are the same as before this last CVA: humid weather, being to hot, an elevated temp, being startled by someone suddenly comes up behind me without speaking to me, staying up too late,

alcohol use. Even the alcohol in mouthwash will get me.

My seizures consist of vice grip strength facial tightening, (which part of my face is affected depends upon which cells are firing.) I can still talk, follow a conversation completely, but sometimes have a headache afterward, or feel tired.

I did have abdominal seizures before I was switched to Keppra. They cause pain in the right upper quadrant, nausea, diarrhea, and just a general "yuck" feeling. Again, no loss or impairment, or speech issues. No flailing or bladder loss either.

I realize people do try to fake seizures for a variety of reasons. I worked psych too long not to know that. I just get frustrated when people insist there's only one kind of seizure or that you must lose consciousness, flail about, and lose bladder control, and bite their tongues, because it just isn't true!

Just for the sake of some poor soul that actually does have epilepsy that you are TORTURING for having a medical condition that you all have not looked into:

There's over 20 different types of seizures there still is very little known about the brain and how it functions. People like the majority of this thread hear the word "seizure" and think dead off tonic clonic in the floor foaming biting etc. Those are actually not as common as the other types of seizures that people do experience. Some yes only experience those and some experience others.

Epilepsy Seizures Are Divided Into 3 Main Categories.

Generalized

...as I stated above; the whole brain is a affected.

Partial Seizures:

Only PARTS of the brain are affected but what makes this so special for you guys? Is CONSCIOUSNESS REMAINS. So yes these people can indeed be acting a total fool and having seizures. These are a fair deal more common. ESPECIALLY when most people think when they hear the word seizure. These are more common then tonic clonic seizures WHY? They haven't made it all the way across the brain. People have been actually misdiagnosed as being schizophrenic if that says anything.

Complex Partial Seizures:

All that I have stated with partial seizures but consciousness is LOST. I think this is what you are looking for with "other types of seizures". People have actually gotten up wondered out of their houses into the middle of the road and gotten hit by cars.

There here is my lecture for hopefully at least one soul with legitimate seizures that you do not torture.

I'm going to leave all of this at one last comment:

if you maul a person's sternum to death and they wake up from a real seizure that's got to be pretty bad. Same as ice. Imagine this yourself. I have seizures if you have not noticed I have been called crazy I have done the stupidest things you can possibly think of. I have bitten off half of my tongue. I have fallen and hurt myself so many times you can't imagine FORTUNATELY this doesn't happen EVERYTIME.

The generalized seizures hurt more than you can imagine so let's toss some ice on that?

Okay, now a seizure is one of those illnesses you can truly spot when you have a faker. People who are having an active seizure will have these things: Elevated BP, elevated pulse, low 02 sat and not be aware of there surrounding or whats going on. In most cases they will urinate on themselves. Not always but most likely. First thing you need to do is a sternal rub. A person who is truly having a seizure will not react. Also hold their hand over the head and drop it. If they avoid the face when it falls they are aware of what they are doing. IF the vitals are fine then most likely so are they. We had fakers where I used to work all the time. They wanted to get out of the zone so they faked it. When they were told that seizures were very identifiable and given a write up the number of siezures in our facility decreased tremendously. Don't be taken advantage of. Know true signs.

Specializes in ortho, hospice volunteer, psych,.

There is so much ignorance exhibited in the above letter that I scarcely know where to begin. I'm not attacking the writer, only the incorrect facts stated above,

With the types of seizure I have, no one but my husband is aware of when I have a seizure. I have, complex, complex partial and abdominal, I do not loss consciousness or awareness, do NOT pee all over myself or anyone else, or and am able to follow and participate in what's going on around me. I have described what my seizures feel like in other posts. By now, I know wha my seizure triggers are, and know for sure why I have seizures.

They began when I was thirteen months old and which type of seizure I have is dependent on which brain cells happen to be firing at that time.

There will always be people who think they know more that the specialists that I've seen or been taken to be seen as a child, and that is both maddening and frustrating. Before I became disabled, I drove, and participated in any sport I chose (with one exception.)

I realize that there will always be fakers out there. I've been a psych nurse too long, but that does not give everyone else to assume that if someone stating that they have a seizure disorder or that they are having a seizure, that they are faking just because you cannot see symptoms that go with a tonic-clonic seizure.

Specializes in Complex pedi to LTC/SA & now a manager.

I've witnessed absence seizures and partial seizures knowing the individual well enough that something was wrong but not aware without an EEG running that they were actively seizing.

Depending on the part of the brain involved vital signs might not change from baseline.

Do not do a sternal rub during what you think is a fake seizure. Even if a fake seizure and person is dramatic flailing all about keeping the person safe not causing pain is the priority.

Look up gelastic (sp) seizures. Another "non-obvious" seizure often un/mis diagnosed. Gelastic and Dacrystic Seizures

ImThatGuy said:
I walked back into the jail once to see an inmate that was having a "seizure" after "falling" off his bunk onto the floor. I radioed to the deputy room and had one of the guys come back with his K9. As soon as Stinger entered the pod on lead the "seizing" inmate jumped to his feet and quickly scrambled back to the top bunk. It was a miracle.

Lol, that is too funny!!!!

Specializes in LTC, Correctional Nursing.

I always carry 2 ammonia sticks with me... I pop them both, one up each nostril combined with a good hard sternal rub, that usually separates the fakes from the real ones. I have worked in corrections for a long time and after seeing a few hundred fakes, when you see a real one, you know it's real. If you start asking them a bunch of questions just as they start to "come around" and they are able to answer them pretty accurately, then they are probably faking it. In a real seizure, they can't think straight enough to answer some of the tougher questions like "are you on seizure meds" & "what kind, last dose" etc...

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