Faking seizures?

[Grodo]

Hello everyone,

I came with a question I've been asking myself for a few days ... maybe someone here can help.

I work at an adult education center (disclaimer: I'm not an EMT!). There is a studentl there (age 28) who regularly has seizures. I've only seen it happen four or five times in the 2+ years that this person has been with us, but she says that it actually happens quite often (1-2 times a month). She has always been quite adamant that we not call an ambulance when a seizure hits, so we never had until now. This past Wednesday, though, she had multiple seizures in relatively rapid succession, and that time we did call an ambulance.

By the time the ambulance came (about fifteen minutes after we called, since they had a bit of trouble finding us), the student was talking in full sentences and appeared extremely tired, but otherwise OK. It may have been another five minutes or so between her having the seizure, and us deciding that we were going to make that call.

Among other things, the ambulance crew asked her what medications she was on, and she said Tegretol. I happen to know this is an actual anti-seizure med. My grandson took it for a while.The ambulance crew asked me to describe what had happened, and I did, as best I could. In hindsight, one of the most striking things, to me, was how this student repeatedly struck her head against the pavement.

After a while, though, one of the paramedics began asking me questions I hadn't really expected. Like whether she had talked or sat up while seizing. It seemed to me he was implying that the seizure might be fake. I did a bit of internet research, and found (through this forum, among others) that some people apparently do, in fact, fake seizures for attention. The thing about this student is that she seems more bothered than pleased when people hover over her.

But then again, that paramedic got me thinking. There are a few things that seem weird about this situation. Like for instance: she is a crutch walker and an occasional wheelchair user. I have never witnessed her having a seizure while on crutches; always in the chair. And I don't often see her in the chair. But being in the chair means that she won't fall to the ground abruptly, even while having a seizure. Also, I witnessed my grandson having a tonic-clonic seizure twice, and both times, it took him at least an hour to come fully out of it. With this student, it's fifteen minutes at most. And even then, it seems like she's invariably aware of what's happening around her almost immediately after she stops seizing. She just can't or won't talk. What seems especially weird to me is that she's always trembling all over her body right after a seizure. Aren't her muscles supposed to be exhausted and therefore limp?

If she is indeed faking the seizures, I'd like to know. If attention is what she's after, it seems to me we souldn't be giving it to her anymore. Maybe then the fake (?) seizures might stop.

[ERDoc]

She doesn't sound like your typical person faking seizures. Without medical training I would recommend you not try to determine if they are fake or not. Assume they are real and treat her as you are supposed to. Many people can tell when they are about to have a seizure so she may know one is coming and put herself into the wheelchair so she doesn't fall. When you say that it took X amount of time for them to "come out of it," do you mean they were postictal? If so, everyone is different. I wouldn't find it suspicious for a 15 min positical period. The paramedic may have been asking those questions just to get a full assessment and had no ill thoughts.

[Grodo]

@ERDoc: I mean she doesn't talk for ten-fifteen minutes after the seizure. Just moans a bit. But she reacts to people calling her name by blinking or nodding. And then when she starts talking again, all of a sudden what she says makes perfect sense.

My grandson is different. He will just lie there staring for at least twenty minutes, then start reacting to questions, but his answers will be mumbo-jumbo. Like, one of the times I witnessed a seizure in him, he was lying on a Cars-themed carpet in his room, and for about twenty-five minutes, the only intelligible word that came out of his mouth was "car". Mind you, my grandson is nine years old and perfectly articulate under normal circumstances.

It just seems weird to me that she could go from not talking at all but being able to recognize her name, to speaking in full sentences within the span of ten minutes. But as you've said, I'm not a medical professional. That's part of why I came here. I wanted to get an idea of whether asking bystanders about talking and sitting up during what is being described as a seizure, could be considered standard procedure.

There are other things about this student that smell a little fishy to me.

She walks with crutches due to cerebral palsy. OK, not that uncommon ... I've had people like that in my class before, though they were both walking without aid. Sometimes, she uses a wheelchair. Miraculously, on days when she has a seizure, she's always in the chair and not on crutches. Being in the chair means she won't fall to the floor abruptly. She also says that she was walking independently (not even with crutches) until five years ago, when she broke her knee and then had a bone infection.

She claims to have had a brain biopsy two weeks ago (which is why she's now wearing a hat at all times, against school policy), for a problem that is unrelated to either epilepsy or cerebral palsy (unclear / double / periodically disappearing vision). But she was absent only one day for that. Really? And when she lost the hat during one of her seizures, I couldn't see any obvious scars or bandages, or even shaved spots on her head. She just has very short hair under there, is all. Also, she broke her glasses during one of the seizures on Wednesday, while in the bathroom (so I didn't witness it). On the one hand, that doesn't seem to me like something a person would do just for effect (I imagine replacing those glasses won't be cheap). But on the other, her glasses broke in a way that I can't reconcile with her having had a seizure as I've witnessed it four times now, in her.

She supposedly has a bad back (says it's a herniated disk) and occasional headaches, but refuses all OTC pain medication when it's offered to her, because apparently her liver can't take it.

That seems to me like a lot of medical problems for a twenty-eight-year-old!

I'm just saying. There's a reason that EMT's questions got my attention!

Edited December 13, 2014 by Grodo

[ERDoc]

Even people in a postictal state can respond to their name. I don't hear anything unusual in the way you explain her seizures and postictal period. I really can't find anything in your description that can't be explained. For brain biopsies, they are doing needle and sterotactic biopsies which are outpatient procedures. They are also using a technique called minimal shave method, where they shave a half-inch square area. Some people just have bad protoplasm and she could be one of them. People with CP tend to have a lot of other bad things going on.

[Grodo]

All right. Thank you, ERDoc.

But what about the shivering. Do you think that's unusual? The way it was explained to me (by my daughter after she'd been to the neurologist for my grandson), muscles should be exhausted, therefore flaccid, after a seizure. If this were actual tonic-clonic epilepsy, shouldn't she be sagging like a rag doll afterwards, rather than shaking like a reed?

[ERDoc]

Not necessarily. Everyone is different. Muscles may be fatigued but they can still twitch.

[mikeymedic1984]

People who fake seizures, do so to get the valium injection. Since your person does not want EMS (which means no meds) they are probably not faking. If they are faking it is for the attention, but you put yourself at risk should you fail to call 911 when this person if faking or not.

[paramedicmike]

ERDoc explained things pretty well.

Surely, in your search for information on seizures, you read about the variety of seizures conditions, circumstances which cause them and recovery periods after a seizure. I imagine, too, you would have read about auras and the ability some seizure patients have to tell when a seizure is coming on. Included in your reading should have been information on different medical conditions which can contribute to someone having seizures, also.

Or were you just looking for information on people who fake seizures?

Nothing in what you have presented here sounds unreasonable or impossible. Assuming that someone is faking is a dangerous position to take.

There is an awful lot of information out there on seizures and related medical conditions. Please approach your education with an open mind and don't assume anything.

[Grodo]

I am finding out that with seizures, anything goes, really.

There are physiological seizures which can be seen on an EEG, but also "pseudo-seizures", where the person has no abnormal brain activity, yet may not be aware of what they're doing. I no longer think this person is faking. I'm still not sure she really has epileptic tonic-clonic seizures, but then again, I suppose that's not for me to determine.

However, the person herself has told me and other people at the school multiple times that really, there isn't a lot that can be done about her seizures. She just wants someone to sit with her until the worst of it is over, and then go about her day. You guys seem to be saying that by honoring her wishes in this regard, the school is putting itself at rik. And that we should be calling EMS every time this happens.

In reality, what would an emergency department do if the seizure is over by the time the ambulance rolls around (as was the case on Wednesday), and the patient says she isn't hurting anywhere? Are there any circumstances under which we can let it go, and not call the ambulance? After all, that's what the patient wants!

In the past, I've sometimes considered the possibility that she might be faking the seizures in order to get an hour's rest. Although the seizures themselves (as far as I've seen) last less than a minute, and the post-ictal period is short, she has high muscle tone and shivers for up to an hour afterwards, and her limbs are pretty much useless during that time. I had never seen that before -- nor have I encountered it, so far, while reading online about epilepsy. But I have to admit that paramedic mike wasn't all that far off. My reading may have been biased towards fake seizures. Off to rectify that right now.

[ERDoc]

I don't think any of us are saying to call 911 immediately. Not all seizures need to go to the ER, especially in people known to have seizures. You also have to honor the patient's wishes, but keep in mind that you still need to take care of her properly. I think the school needs to have a conversation with her and get in writing a plan for what to do when she has a seizure.