Fake Seizures

[training medic]

Zebras or no zebras, in normally healthy young adults that have a syncopel episode with seizure, a prudent Medic would not just rule out faking, even though it might be. One thing to consider is IHSS. If you have not seen this in a patient just look in the news of young High School athletes dropping dead on the field or Basketball court. My point here is don’t rush to put a patient in a certain category, but use your skills and tools to rule out the potentially lethal issues first.

[A Pox On This Place]

Thoughtful responses all. I've had some experience with pseudoseizures too and I'm convinced several I dealt with were likely stress related. I thought about whether my patient yesterday may have had a stress trigger to an actual medical event. I don't know.

[training medic]

Zebras or no zebras, in normally healthy young adults that have a syncopel episode with seizure a prudent Medic would not just rule out faking, even though it might be. One thing to consider is IHSS. If you have not seen this in a patient just look in the news of young High School athletes dropping dead on the field or Basketball court. My point here is don’t rush to put a patient in a certain category, but use your skills and tools to rule out the potentially lethal issues first.

[Bernhard]

Check SpO2 during seizure. If it doesnt drop, chances are high it's not a seizure, but rather a hyperventilation tetany or a fake.

Doesn't help much after the supposed seizure, though.

[DwayneEMTP]

To the best of my knowledge I've seen two pseudoseizures. If I had to distinguish between the two..

First, the pseudoseizures seemed genuinely afraid. At times they would be lucid only moments after the seizure activity ceased and seem to genuinely want me to make them stop, clearly begging for help before the next one began. The fake seizures that I believe that I saw knew better than to do such a thing.

The second, when the ER doc says, "Let's go ahead and put in a Foley..." and they immediately start yelling, "Fuck you man! I don't want that thing in me, fuck you! I don't need that thing in my dick!" I consider that a positive result for the bullshit test.

And though I appreciate the sentiment TM, I don't think that anyone is suggesting that jail cell/court room plus seizure activity equals bullshit. Only that bullshit, after a thorough exam, is encountered in that environment more often than in some others.

Though I've seen many of what I believe to be fake seizures I would never assume that in the beginning. Not because I'm a better medic than those that would necessarily but because it just isn't interesting. It's been incredibly rare that I show up to witness the active seizure so only have a bystander's report of what happened. When I show up and see no bleeding tongue, no poop or pee, no postictal state, then I immediately begin to wonder what else they might have seen and try and catch that. It's just more fun that way...

[A Pox On This Place]

When I show up and see no bleeding tongue, no poop or pee, no postictal state, then I immediately begin to wonder what else they might have seen and try and catch that. It's just more fun that way...

Dude, your concept of fun is interesting. Mildly disturbing but interesting nonetheless. And quite correct, I think. I'm a dinosaur about assessing in courts/correctional environments... (You can always tell a public safety lifer but you can't tell him much! And please, speakly slowly with no medical terms more than three syllables.)

Edited June 1, 2012 by A Pox On This Place

[JPINFV]

With the amount of mental illness we encounter, I would not call it a zebra. No one else has ever seen a pseudoseizre?

1 patient, 4 times during the call, but that patient also had a signfiicant psych history including conversion syndrome and was being picked up from an outpatient county psych office.

[Kiwiology]

With the amount of mental illness we encounter, I would not call it a zebra. No one else has ever seen a pseudoseizre?

I'M TAKING TEH LITTLE PILLZ THE SIGHKAYATRYST GIVES ME! stop judging me

[A Pox On This Place]

I'M TAKING TEH LITTLE PILLZ THE SIGHKAYATRYST GIVES ME! stop judging me

Go back to the Acitivity Room NOW.

Or the leeches go back on.

[Charlie Clark]

That is something that so many people take for granted. While you are having a fake seizure, someone out there is actually having a real one. It is difficult knowing which is which, but in the end, their conscience will ride them. In this field, there is no time in deciding if it is fake or not, it is litteraly a matter of acting on what you see. When you are trying to save someone's life, just to find out that they took you for a fool, makes you almost whish that that person could have a real one, just so they can see that it is no joke.