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A Pox On This Place

Fake Seizures

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I had a familiar call to a district courtroom yesterday, a 24 y/o male having a "seizure" at his sentencing hearing. We got there about three minutes after court staff said his seizure passed. He was alert, lucid and oriented and had no problem answering SAMPLE. He had the vitals of a pro cyclist (P-50, BP-110/60, R-12). He declined transport or further treatment. Fake seizures and sentencing hearings have always seemed to go together.

If people are going to waste our time can't they even go through the motions of pretending to be postictal too?

What are your experiences?

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We see cellitis fairly regularly. Usually presenting as chest pain secondary to a DUI arrest. Haven't really done too many fake seizures though.

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How can you be sure the pt was faking the seizure and not suffering from PNES?

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How can you be sure the pt was faking the seizure and not suffering from PNES?

Good point, in the field (and with my modest level of training) I had to rely mostly on what the patient told me to rule out epilepsy, syncope, vertigo, migraines or a stroke. Can PNES even be diagnosed without long term EEG monitoring?

In this case I took how clear and lucid he seemed, the complete absence of postictal fuzz and thought of my last two dozen calls to seizing/sycopic people in holding cells or courtrooms who were facing immminent sentencing. A jaundiced view I admit.

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On another thought that the patient had a vagal response due to the stress and had a syncopel episode followed by a hypoxic seizure. That would explain the vital signs and no postictal period.

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Or that he was faking, that would have explained it all too. Let's not forget the trees or the zebra and try not to overanalyze.

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Extremely rare here

When I was stuck at the airport for 6 days straight I thought about faking a seizure to get a hospital bed and a hot meal for the night but never did, I figured the San Francisco Fire Department had better things to do

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Can seizures be faked? Sure. Obviously you need to take the situation into context as part of your overall assessment. Just because someone was not post ictal, incontinent of urine, or have bitten their tongue, it also does not mean it wasn't a seizure.

That said, if a hysterical 16 year old female who just had an argument with her boyfriend c/o chest pain, would you immediately give her a couple NTG's, ASA, alert the cardiac cath team, and fire off a 12 lead EKG on her, to rule out an MI?

As was mentioned, zebras may be interesting, but unless you live on the African plain, they simply are not very common.

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

Edited by ERDoc

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I've dealt with a number of false and pseudoseizures. In my limited experience, though, it's extremely difficult to try and discern whether or not the seizure was truly psychogenic in nature or intentionally faked. Trying to determine the intent or absence of one by someone who on outward examination SHOULD consciously know they're not really seizing isn't an easy thing; I think in general we err on the size of assuming the person is full of shit and forget that fake and psychogenic are not the same thing.

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