Strange diagnosis

[aerorunner80]

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.

[zenman]

Spend one shift in an ER.

Oh, yes, the good old ER days.

The "blind" guy who stepped over a broomstick that I was holding horizontal a few inches off the floor as the doctor walked him out of the exam room.

The people with "severe" leg pain. Exam them supine then turn them over. In a few minutes ask them "now which leg was it" and laugh as they try to figure out which one was hurting.

The "unconscious" patients. Hold their arm above their face and drop it. Funny how it always seems to miss their face!

Etc, etc.

[JR816, BSN, RN]

there was also an er episode about this condition. the pt. had a child die from sids and couldn't hold any of her other children because of the "seizure" activity. it was kinda interesting.

[psalm, RN]

If it is a true seizure, doesn't the person lose control of bladder? Would that rule out a true seizure, if the pt. always was in control of bladder?

[woody62, RN]

A seizure is diagnosed by an EEG. And while there are several types, they are all very real. I had my first one in 1990. And the only reason I suspected one was

1. I had had a third closed head injury in 1989.

2. My nightclothes and bedsheets were wet.

I was referred to a neurologist you did a sleep deprivation EEG on me, which showed the seizure. I also had an MIR and PET scan, which both confirmed my seizure disorder. I have been on medication since 1990. And haven't experienced one since 1997.

I also have adult onset asthma. And it is trigger by exposure to cat dander and some tree pollens. I share this because while there are a number of fakers, there a great many more people who truly suffer. And are sometimes treated poorly by ER staff because they become labeled with being a 'frequent flier.' I am a frequent flier for my asthma but believe me, when I show up in your ER, please have the nebulizer handy. By then my O2 sats are down in the low 80s and I'm not long for this world without a treatment, unless you get a kick out of coding me.

Woody:balloons:

[IMustBeCrazy]

They may not void, due to many factors. One of which may be just voiding prior to the seizure.

I have cared for many pseudoseizure patients. I find it interesting that many of them have comorbid personality disorders.

The most interesting pt I have taken care of is one that comes to the unit about once every 2 months or so. Timing seems to coincide with when she doesn't have much going on at home, and wants to see if any of her 'friends' are on the unit. She is a smaller woman, but is known to bench press 100 pound chairs when she has one of her "seizures". Interesting but very behaviorally-induced.

[Monica RN,BSN]

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.

Or just in fact her manipulative actions to gain attention

[Thunderwolf, MSN, RN]

I have cared for many pseudoseizure patients. I find it interesting that many of them have comorbid personality disorders.

Ditto on that.

Also, consider the need to rule out substance abuse/dependency with the pseudoseizure as a drug seeking behavior (ie Ativan).

[NurseLatteDNP, MSN, DNP, RN]

If it is a true seizure, doesn't the person lose control of bladder? Would that rule out a true seizure, if the pt. always was in control of bladder?

That's what we were thought durng our seizure lecture.

I have witnessed a fake seizure on a teenage girl. It was so obvious, while we were asking her mom the admission questions, the girl would 'snap out' of her seizure several times to correct her mom, and then she would continue seizing like nothing happend. She also would do it when her mom told us that she will be leaving to check on her other children, the seizures all of a sudden start. After her mom decides to stay, the girl would stop. It was very sad. After she was seen by a doctor, he had ordered for a psych consult.

[bigsyis]

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...

Emmanuel, I have to commend you for the very thoughtful and kind description of a woman who is known to fake seizures. Anybody who has been in ER very long has seen their share of this, and quickly become very cynical about it. From previous threads I know of your ER experience, and I am thankful that you have remained so objective in your description of pseudoseizures.

[teeituptom, BSN, RN]

I think psuedoseizure patients are so much fun. One its fun to watch the new nurses get all excited by it. Its fun to watch the patient in all their silly games associated with it. And its fun to see how their families react and feed into it. I remeber 1 mother of a teen age girl, grab my arm and tell me her doctor says she has pseudoseizures and only dilaudid will help her. Its amazing the way they act and how their families respond to it.

I remember another mother ask about her child, she goes Tom exactly what is a pseudoseizure, what kind of seizure is that. The look of terror on her face when I told her that was a nice way of saying Fake seizure. She asked if that would be terminal. Gotta love it

[bigsyis]

II remember another mother ask about her child, she goes Tom exactly what is a pseudoseizure, what kind of seizure is that. The look of terror on her face when I told her that was a nice way of saying Fake seizure. She asked if that would be terminal. Gotta love it

Denial isn't only a river in Egypt. Geez! Wonder what part of fake she thought would be fatal?

[all4schwa]

Just to sum it up and clarify: sometimes the pt know's they are faking it and have ulterior motives. Other times, they dont know that's it's not epilepsy, it feels real to them and is actually a stress reaction fromt the body. Usually treated by managing underlying psych issues.