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.

[MadisonsMomRN, BSN, RN]

Just curious...

do these types of seizures have a post ictal period like say a grand mal seizure??

Are these really seizures? (the pseudo-seizures) I assume that these types of seizures are hard to differentiate between a true seizure?

[caroladybelle, BSN, RN]

Spend one shift in an ER.

Heck, any medsurg floor gets them.

We had one that was so convincing that the interns actually called a code on. Then during the "code", she sneezed/coughed.

I've dealt with several that had "seizures" when refused any more ativan or morphine.

But pseudoseizures are scarier.

[EmmaG, RN]

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.

Oh, goodness no. I never worked in the ER. I hope I didn't leave anyone with that impression...

[EmmaG, RN]

Just curious...

do these types of seizures have a post ictal period like say a grand mal seizure??

Are these really seizures? (the pseudo-seizures) I assume that these types of seizures are hard to differentiate between a true seizure?

No, they don't have the post-ictal phase. It's all pretty complicated. There are so many variables to consider. Somewhere in that article I linked it mentioned past abuse, PTSD and so on being a common factor in their histories. Then there's the whole gender issue; it's much more common in women. How much of it is on a conscious level and how much is a subconscious defense mechanism? Society "allows" men to externalize their aggression, frustrations, anger and fear; they are allowed the outlets to deal with these feelings (boys will be boys!). Women are not (be a good girl!). Eh. I'm rambling now LOL. I'm not a psych nurse... but my rusty brain tells me that dissociative reactions can't just be turned on and off. Then of course there are the ones who do consciously "seize" for the attention, meds, etc. Very difficult to deal with... fascinating, but difficult.

[zenman]

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

What would happen if you put a golf club in her hand while "seizing."

[MadisonsMomRN, BSN, RN]

No, they don't have the post-ictal phase. It's all pretty complicated. There are so many variables to consider. Somewhere in that article I linked it mentioned past abuse, PTSD and so on being a common factor in their histories. Then there's the whole gender issue; it's much more common in women. How much of it is on a conscious level and how much is a subconscious defense mechanism? Society "allows" men to externalize their aggression, frustrations, anger and fear; they are allowed the outlets to deal with these feelings (boys will be boys!). Women are not (be a good girl!). Eh. I'm rambling now LOL. I'm not a psych nurse... but my rusty brain tells me that dissociative reactions can't just be turned on and off. Then of course there are the ones who do consciously "seize" for the attention, meds, etc. Very difficult to deal with... fascinating, but difficult.

Oh ok... gotcha (sort of:lol2:) My 9 yo has had two seizures (when he was six) and they put him on Trileptal. (he had generalized aka grand mal seizures both times with the horrible post ictal phase afterwards) His EEG's, CT scan's and MRI's were all normal. It just seems that each time he had one that a stressor could have brought it on (wishful thinking I guess). He has been seizure free for over two years and is newly weaned off of his seizure meds... we are crossing our fingers!!

Thanks for the interesting info.

[bigsyis]

Oh, goodness no. I never worked in the ER. I hope I didn't leave anyone with that impression...

Hmmmm...guess I didn't know as much as I thought I did!:uhoh21:

[teeituptom, BSN, RN]

ER is the only place to work to see everything

[leslie :-D]

i once dealt w/a highly upset mother, who had a pseudoseizure.

she was in our hosp and was whisked to the er.

extensive testing produced this dx.

this mom even became incontinent while 'seizing'.

leslie

[all4schwa]

I've had psuedo's where the pt bit their toungue so hard there was blood all in the bed. I've also seen them drop their sats, not too sure how they do that.... Sometimes, so much effort goes into these seizures, they are post ictal just from the effort.

And, they do look like real seizures (for the person that asked). They say, but I've never been present for it, that you can hold smelling salts under their nose, or give supraorbital pressure (very noxious stimuli) and it will bring them out of it.

[teeituptom, BSN, RN]

Had one whose husband told me that if we didnt give him, his dilaudid soon he would have a seizure.

Had another who in the middle of seizure his cell phone rang and he stopped to answer it. I smile a lot a lot at life in general

[santhony44, MSN, RN, NP]

I have probably seen more patients wet themselves having pseudoseizures than patients having real ones. The ones who are consciously faking probably read up on what seizure patients are "supposed" to do. I didn't find voiding during seizures to be that common.

Sometimes it's just impossible to differentiate without having an EEG going at the time of the event (though a real generalized seizure with cyanosis and so forth would be pretty darn difficult to fake all the way through).

We had one guy who suddenly, in the middle of the night, laughed out really loudly, flipped from his back to all fours, and cursed a blue streak. I never would've believed it had I not seen the EEG go wild all over the screen. (I've never seen anybody go from the back to all fours like that, like a cat. He didn't roll, he flipped!). They were able to localize his seizures and he had successful surgery.

Sometimes people forget that there are more seizures than the big generalized ones, and the variety of behaviors exhibited was pretty interesting, depending on where in the brain the activity was.