Strange diagnosis

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Specializes in MSN, FNP-BC.

I saw a diagnosis of "pseudoseizure" on a patient when I worked yesterday. Is this a real diagnosis? How can you have a fake seizure? It doesn't make any sense to me.

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Yep. They are also called dissociative convulsions or dissociative seizures. I recently had a patient diagnosed with this, and I've taken care of a number of them in the past. While it's rather difficult to come to that diagnosis, some are suspect from the start.

This particular patient was noted to have seizures only when her family was present and awake (while they slept at her bedside during the night, she never had any episodes, until they awakened) She also had them during EEGs and MRIs--- which incidently showed no signs of seizure activity even though she had at least 6 during each test. Her seizures ranged from staring off into space to full-blown tonic/clonic activity to waving her arms in the air... each one was different. During one of her seizures, she went completely limp and stared off to the side. She wouldn't respond to the pleas of her family to "snap back"... but when her supposedly-flaccid arm was held over her head and let go, she moved it so that it would not drop onto her face. She was also noted to come out of her seizures when her husband came into the room with take-out, for example. You get the drift.

It is extremely frustrating to deal with these patients, as they sincerely believe they are having 'true' seizures, and resist any attempt to convince them otherwise, and therefore resist any treatment that could help them resolve their problem. Again using this patient as an example, she and her family were furious when told she had pseudoseizures, and demanded to be transferred to a teaching facility that would effectively treat her "epilepsy". After those docs reviewed her case and test results and determined it was indeed a case of pseudoseizure, they demanded to be transferred to yet another university hospital. And so on. All the while refusing to be discharged until such a transfer was arranged. The last I heard, they did manage to get her discharged, but I have no idea where she ended up. Sad case; she obviously had psych issues that will probably never be addressed because of her (and her family's) refusal to accept the truth...

ETA: here's a very informative article on the disorder: http://www.e-epilepsy.org.uk/pages/articles/show_article.cfm?id=48

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Specializes in Travel Nursing, ICU, tele, etc.

Yes, I worked on an epilepsy unit where often people had been treated for seizures for years and only when being continuously monitored with an EEG (with helmets, etc) and constant video monitoring was it discovered that they did not and likely never had a seizure disorder. Often these people had deep-seated psychological disorders. Very sad really. :o

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Another was a 30-something woman who was always being admitted for asthma (that could never be officially diagnosed either). On every admission, when it came time for her to be discharged, after the doc informed her she was to go home, she'd either have an unwitnessed fall or a "seizure".

So it got to where when we'd read in the progress notes he was going to d/c her, we'd pad her rails and turn on the bed alarm.

She once came out of one particularly impressive seizure episode when her cellphone rang. The seizure then continued after she hung up :uhoh3:

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Very sad really. :o
Very. The one I posted about above had led such a hard life. Abuse, neglect, you name it. I'm sure these seizures were her 'defense mechanism' in response to all she'd suffered.
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Specializes in ER then CVICU now.

I get alot of seizure patients where I work and while most of them are real, there are a few people who fake them.

I once had a patient who came in with seizures, whose husband babied her.... every little thing he would come and get me. Anyway, I witnessed her so called seizure, this lady was flopping like a fish out of water, she had the whole stretcher shaking and banging into the wall, about 3 nurses and 2 attendings stood and watched this lady's' horrible performance. When she was almost off the stretcher by her violent jerks, she laid with her eyes closed for about 1 minute and opened her eyes and was awake and alert. I thought to myself that she could have at least pretended to be in post ictal for about 10 minutes.

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Specializes in ICU, ER.

How can you have a fake seizure? It doesn't make any sense to me.

Spend one shift in an ER.

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Specializes in Travel Nursing, ICU, tele, etc.

Yes it's true, some people are so unbelievably desperate that they would do anything to escape that desperation for awhile, even if they are not doing it consciously. People can honestly believe they are having seizures, but it is psychosomatic... brutal..

We can't judge these people, it isn't an intentional act to manipulate. As well as the patients who are faking as they have a different set of mental health issues going on...

You can get quite a mix of people in an epilepsy unit.

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Spend one shift in an ER.

Totally agree!!!

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

I've also worked in an epilepsy unit, and these are more common than you might think.

I saw one patient who had documented seizures and then surgery which was quite successful. She then reappeared in our unit having pseudoseizures. Her life had become centered around being epileptic and she couldn't cope with no longer having seizures. I don't think this was conscious on her part.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Completing a code with successful intubation intervention, we were moving patient out of room when I glanced across hall to see another of my patients having appearance of grand mall seizure with full bed shaking.

Code team zipped in and gave the guy large large amounts of meds (don't quite remember after 17years) took 6 of us to prevent him falling out of bed. Took him up to CCU too ...only to have CCU RN call me and inform me 1hr later tried to hang himself with wall BP cuff....

DX pseudoseizure and Munchausen

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