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real seizure versus fake seizure


fiznat

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I'M CURIOUS AS TO WHAT WAS THE THE PSYCHOANALYSIS OF THE 17YR OLD?

(Without Prejudice)

Thats fine if you find this humorous your allowed, my concern is what became of her?

When you hear that it affects children thats my concern as it would be yours as the Individual (EMT/Medic)

So wining an oscar hmmm, so what if it was your kid, are you going to call their bluff?

It must be hard to deal with it but of course your not a psych major

Actually, I do call their bluff and tell them to knock that sh*t off! ... after experience you can usually tell those of seizing or not. Past history, med's, and post ictal behavior. Check advanced neuro assessment, and treat accordingly. I respond to about 10 to 15 seizure calls a week about 4 or 5 are real. Yes, I have been dooped, no shame.. far as lab test myoglobin only shows muscle activity which will increase even if faking, an EEG is requires to document seizure activity.

Most all the psuedoseizures are dramatic, and try to remain conscious during their activity. Yes, there are types that have to deal with behavior, psych and yes they can be conscious.. but a lot of these have other symptamology and know about their condition.

Again, treat according real or fake....

R/r 911

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The lab test is a prolactin level, which is usually elevated for a short period after a seizure (about 15 minutes or so). Does it really matter is someone gets one over on you? It doesn't make you any less of a provider. As long as you are doing the right thing, then no big deal. So what if you just gave some junkie their fix. It happens to everyone at some point, reguardless of how much experience you have. Just be alert to it so you don't become their supplier.

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So wining an oscar hmmm, so what if it was your kid, are you going to call their bluff?

It must be hard to deal with it but of course your not a psych major

I would like to think that I would call their bluff. Obviously there is something seriously wrong with this young patient, be it some sort of medical pathology or be it psychological: the answer would never be to simply let it go and "hope it resolves," as it seems this mother was attempting to do. I do feel sorry for the patient, and I do wonder what exactly is going on with her if it is in fact psychological-- but to get this good at faking seizures requires practice, and practice to me means lots of neglect of this issue by the parents. At this point, I dont feel like the behavior should be reinforced by allowing ourselves to be taken into the act. If she is faking, she needs to cut it out.

Coincidently I actually am a psych major. Finished my double major in psych and philosophy at Boston University in 04. Suprise! haha :wink:

Just another point, her seizures weren't "obviously" fake if the ED staff felt the need to medicate her with another millgram of Ativan.

I was wondering about this as well, and I actually asked the same question of the doc in charge. He basically said that they "just gave it anyways to calm her down," presumably so that she would be easier to deal with for the ED staff. Psychs get ativan too, I suppose. heh

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As far as your treatment of the Seizure activity, I don't thing you could have done it any better. If its not obvious to you, your partner or the ER staff I would be willing to bet you were right. Of course there are a few people who are damn good at faking seizures, and even if they did fake it you won't be getting sued later on for it. Just remember, if it looks and smells like something...its usually true.

On another note, a patient doesn't have to be unresponsive, icontinent and having a full tonic clonic seizure to benefit from treatment. I have seen a few patients (however rare) that suffer from focal motor seizures usually after a stroke event that have no diagnosed seizure history. These patients usually are still able to talk but act disoriented and somewhat lethargic like a diabetic. Just keep alert and do your best!!

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In the course I'm currently studying, we had a lecture a few weeks ago on seizures, here are a couple of points:

- there are four classification of seizures - partial seizures, generalized seizures, unclassified seizures and non-epileptic sezires (the last being your pseudoseizures)

- unclassified seizures are ALL seizures that cannot be classified because of inadequate or incomplete data and some that defy classification

- non-epileptic seizures have no organic cause and are usually psychiatric based

- may appear similar to epileptic seizures but there is no electrical discharge

- these can be due to panic attacks, inability to cope with emotional demands, post trumatic stress, no control over behaviour, manipulative attacks.

- activity is disjointed, non synchronous, non clonic, disco-ordinated motor activity, pelvic thrusting, back acrhing

- even though presentation is not the same as "normal" seizures they are still classified as seizures.

I was looking after 19year old female, presented with asthma, tachypnoeic, tachycardic, low SpO2, began to have a tonic clonic seizure, ABG showed respiratory and metabolic acidosis. Doctor persisted to tell us she was faking the seizure and it was a pseudoseizure, only because she was maintaing her own airway. However, she was unresponsive, had full tonic clonic motions, not responding to midazolam, and was in a post-ictal state for 2 hours post seizure activity.

A good way to tell whether the patient is putting it in is by brushing over their eyelashes, if eyes move under the lids, and they open slightly than it is a good indication that the seizure is fake.

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1) Her seizure motion was not bliaterally equal. The patient was shaking both arms, but they were seemingly at random and not in sync with eachother at all. The doc stated that "real seizures" generally present with bilaterally equal, or close to bilaterally equal tonic-clonic motion. I have never heard of this before.

2) Her motion was too purposeful. While she never accomplished any sort of task with this motion, according to the doc it was obvious to him that the motion was not genuine seizure motion, but rather a calculated, conscious motion. I dont know how he was able to determine this. She certainly looked like a real seizure to me.

3) Her mother's story didnt add up. A 45 minute seizure doesnt "just resolve" like the mother stated it did last time, and patients who have these seizures dont end up with no dx and no meds - which was the mother's story.

I had to readdress this thread because there are several things just sounded hinky to me. First off Dr's point # 1 = B.S. Dr's point # 2 = absolutely true. Dr's point # 3 = first time seizure activity NYD would not have any anticonvulsives prescribed. Also, in my experiences the layman is notoriously bad at reporting mental status. They just don't notice the right things or ask the right questions to properly assess.

ERDoc,

I was always under the impression that there was no conclusive way to determine whether a seizure was in fact "real" or not, so I asked around. The consensus is that prolactin levels do not conclusively indicate a true seizure. Does "medical stamp collecting" ring a bell? It seems that at some point someone did a inacurate study, with poor controls and test group sizes and then published the results which were then dispproved. XYY chromosome anybody?

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Since you obviously need soem help with 'seizures...'

Okay I appreciate the links and all that, but I dont think it is obvious (or even true) at all that I need help with the basic definitions of a seizure. I'm asking specifically about treatment of potentially fake seizures in the field, not about what a seizure IS. I'm not sure if it is meant that way, but you're coming off kinda rude..

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Okay I appreciate the links and all that, but I dont think it is obvious (or even true) at all that I need help with the basic definitions of a seizure. I'm asking specifically about treatment of potentially fake seizures in the field, not about what a seizure IS. I'm not sure if it is meant that way, but you're coming off kinda rude..

"Fiznat,"

In order for one to appropriately recognize 'fake vs real' seizures, one must first UNDERSTAND, AND KNOW the underlying, physiology, pathophysiology, etiology, and DDX of the D/O, before you can even begin to make a 'decision' clinically as to whether your patient is 'actually' having a seizure or not. Since YOU asked I tried to help and it is evident based on your responses that you needed more information, and help with this. the links will get you started on this path, and if you need more help feel free to ask.

As evidenced by the following comment of

Anyways, I'd like to hear what experiences you guys have had with seizures. What kind of criteria/tests do you like to use to differentiate between real and fake seizures, and do you think there was anything that my partner and I could have done differently on this call?

It is clearthat at this point you aren't in a position to be judging as to what is 'real and or fake' hence the 'obvious' comment I made! An appropriate neuro exam and H&P-P/E would have given you the proper answer.

Good luck,

ACE844

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