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.

[bigsyis]

Before I get bashed, I am NOT recommending that anyone do this, but a night Charge RN in the ER that I worked with once brought a 30-something female that was having her 3rd pseudoseizure that week (brought in by EMS all three times) by doing a nipple twist after an ammonia inhalant, supraorbital pressure, sternal rub, and clavicular pressure didn't. That chick sat straight up on the stretcher, cursing both of us for everything she could think of. I cringed, imagining the sensation, but I have to say-it worked. We never saw that gal again.

[twinmommy+2, ADN, BSN, MSN]

Before I get bashed, I am NOT recommending that anyone do this, but a night Charge RN in the ER that I worked with once brought a 30-something female that was having her 3rd pseudoseizure that week (brought in by EMS all three times) by doing a nipple twist after an ammonia inhalant, supraorbital pressure, sternal rub, and clavicular pressure didn't. That chick sat straight up on the stretcher, cursing both of us for everything she could think of. I cringed, imagining the sensation, but I have to say-it worked. We never saw that gal again.

Oh my Lord!!! Nope, can't quite imagine doing that one but good for her for doing it!

I am new to the ER and had my first pseudoseizure this weekend. Of course like someone else said I was all exited and adrenaline pumping. But when I shined the light in both of her eyes, she turned her eyes away every time. At the time I was only concerned about looking at her pupils, not that she was reacting the same way every time I did that. Then the charge nurse who was watching had me step out and said "yep, its a pseudo seizure". I was like "well damn I wish someone would have said something to me before I started gushing over her like that" We just both laughed.

Everytime her friend was in the room, it was seizure city. If her friend left for something, then nothing.

[leslie :-D]

Before I get bashed, I am NOT recommending that anyone do this, but a night Charge RN in the ER that I worked with once brought a 30-something female that was having her 3rd pseudoseizure that week (brought in by EMS all three times) by doing a nipple twist after an ammonia inhalant, supraorbital pressure, sternal rub, and clavicular pressure didn't. That chick sat straight up on the stretcher, cursing both of us for everything she could think of. I cringed, imagining the sensation, but I have to say-it worked. We never saw that gal again.

hmmmmm. :chuckle

can't say i'd recommend it, but enjoyed the visuals.

leslie

[teeituptom, BSN, RN]

hmmmmm. :chuckle

can't say i'd recommend it, but enjoyed the visuals.

leslie

I wouldnt do that either

and that might be viewed by some as unnecassary

If they are having a pseudoseizure, why are they. Is there something else thats needs dealing with

[sirI, MSN, APRN, NP]

Just an FYI: nipple stimulation is not acceptable as a noxious stimulus.

The commonly cited CENTRAL noxious stimuli are:

1) sternal pressure (NOT sternal rub)

2) supra orbital pressure (unsuitable for frontal and base of skull injuries)

3) Trapezius squeeze

4) Less common but effective - pressure over Temporo- mandibular joint

Here is one reason we do not do sternal rubs:

[NYnurseatheart]

i thought i would join in on this thread because i have seen numerous real, and pseudoseizures.

i know there are many different kinds of seizures. are there different types of nonepileptic seizures too? what causes them?

yes. nonepileptic seizures are classified into two major groups: physiologic and psychogenic.

physiologic nonepileptic seizures are caused by a variety of conditions that can be the result of sudden changes in the blood supply to the brain or in the sugar or oxygen levels in the brain. these include changes in heart rhythm (cardiac arrhythmia), sudden drops in blood pressure (syncopal episodes), or very low blood sugar (hypoglycemia). other physical conditions, such as sleep disorders and movement disorders, may have symptoms or episodes associated with them that can look like seizures. it is important to get these sorted out by a physician.

psychogenic nonepileptic seizures seem to be caused by stressful psychological experiences or emotional trauma. psychogenic nonepileptic seizures are one way that the body indicates excessive stress.

do you mean that people having psychogenic nonepileptic seizures are faking?

no. it is very important to recognize that these seizures are real events, although they are different from epileptic seizures. in the past, they were sometimes called "pseudoseizures" or "hysterical seizures" and people having them were thought to be making them up or trying to get attention. we now know there is nothing false or insincere about these seizures, and it is important to diagnose them correctly so that people who have nonepileptic seizures can get appropriate treatment.

this was from the epilepsy foundation

the following is from the university of michigan:

researchers at the u-m epilepsy clinic are experts in the diagnosis of pseudoseizures. "the vast majority of people diagnosed with epilepsy, do have epilepsy," says selwa, a clinical associate professor of neurology in the u-m medical school. "when seizures are prolonged or unusual in character, that should raise concern about whether patients have pseudoseizures, rather than epileptic seizures."

what doctors need to understand is that those who suffer from pseudoseizures are not pretending. the seizures are real and dangerous and it is important to diagnose the disorder correctly, so the appropriate treatment can be offered, says selwa.

i wanted to point out the not faking part, simply because having worked in the er a few different times in my career (currently in a trauma er), i have seen many who have faked, who were extremely obvioius. yet i have also seen some that have fooled even very experienced neurologists. i believe this happens because the patient is not faking, the seizures are very real to them. one in particular would become cyanotic (with correlating drops in o2 sat), incontinent, and would be post ictal for at least half an hour. this particular girl had bitten her tongue a number of times, and once aspirated during a "pseudoseizure", ending up on a vent with pneumonia. so, for those of you who become cynical, and irritated by those "fakers", please be aware that sometimes there is very real danger to a patient. i truly think that some of these people can not control it at all.

on the other hand, we all come to know the ones who fake it, in order to get benzo's or whatever their drug of choice is, or even for other self serving reasons (boredom perhaps?). to those patients, my empathy has dried up.

just wanted to share.

ny nurse at heart

[aerorunner80, ADN, BSN, MSN, APRN]

THANK YOU to everyone who posted here! You all gave great information and I now understand the dx better.