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Thread Title: Is she faking seizures?
Created On Thu Mar 13, 2008 11:11 AM
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divamom
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Thu Mar 13, 2008 11:11 AM

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Hello. I am not in the medical field but I was hoping to try to get some information. I have a cousin who is in her late 20's who I believe has been faking seizures since the age of 18 or 19. Although her first one could have been real, I truly believe she has been faking it since then to get attention and as a way to be be coddled and cared for by family members for the rest of her life. I am not aware of a diagnosis of any mental disorders but she has certaining shown strong signs of it over the years. My father who is of no relation to her is bi-polar so I do have that frame of reference.

She has had countless tests over the years to try to find out the cause of the seizures but nothing ever shows up. She was even tested over night after having been made to stay awake for 24 hours.

If someone has a seizure, wouldn't they be very tired and need to sleep and not have the energy to go off ranting and raving at everyone? These "Seizures" are also timed around things that other family members are dealing with and the focus is not on her. She cannot even leave the driveway without calling her mother or other family members about something and calls everyone countless times during the day and night. Whenever you see her, she tells you about whatever medical ailment she has going on at the time (like she is in her 80's or 90's and not 27). She goes to the ER all the time! They should have a revolving door just for her. She goes if she just has a sniffle!

I have to keep my distance from her because I refuse to get wrapped up in it. Her mother will not admit that she has mental problems! My cousin is taking seizure meds (Neuratin sp?). What are the ramifications of taking medications such as this if you do not need them? She has gotten noticibly thinner over the years.

Any information you could provide would be appreciated, thank you!


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PARAMEDICMIKE
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Thu Mar 13, 2008 12:25 PM

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Originally posted by: divamom


I have to keep my distance from her because I refuse to get wrapped up in it.


With all due respect, doesn't this sum up how you should be handling this situation?

For what it's worth, we are a group of prehospital providers. Granted, there are several on here who are exceptionally educated and experienced. However, we're not doctors. Nor are we capable of confirming or disproving a "diagnosis" based on the second hand account of someone who refuses to get wrapped up in it.

Family members who vie for attention can do so in many ways. We may even suspect that their actions (e.g. temper tantrum = seizure) may be psychological in nature. You said she's seeing a doctor extremely regularly. What more would you like to see happen?

Good luck to you.

-be safe



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-be safe
Aut inveniam, aut faciam.
"There is an incessant influx of novelty into the world, and yet we tolerate incredible dullness."

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Ridryder911
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Thu Mar 13, 2008 12:32 PM

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Although, one thinks of the typical "epleptic seizure" of having spastic movements, there are several hundreds of different type of seizures that are not the "typical" type. They only can be detected by EEG (brain wave) and detailed examinations. One does not have to loose consciousness, incontinence, as even many health care professionals presume.

It does although sound very suspicious upon the scenario you described. She appears to have poor coping mechanisms, and as you described attention seeking behavior. I would not doubt there may be some form of mental illness, the degree and depth again has to be evaluated by a medical professional.

I too would not to be to involved if this matter seems to be overwhelming that are close to her. The only true medical advise I would give is for her immediate family seek professional help for her.

Good luck,
R/r 911

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RN,CCRN,CEN,CCEMT/P,NREMT/P & all the other vowels. Yep, I still drive an ambulance...

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divamom
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Thu Mar 13, 2008 1:06 PM

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Thank you for your polite response. The first response was very condescending. I will take your advice and encourage my Aunt to get her evaluated. I just hope she will listen...

Thank you again!

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jsadin
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Thu Mar 13, 2008 9:49 PM

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You aint seen nuttin' yet. ;*)

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roblanious
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Fri Mar 14, 2008 5:47 AM

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I would like to add to what has been said already that we see pseudo-seizures on a common basis in the ED. These are seizures based upon a psych issue, often called fake seizures. If is sometimes comical as some will shake around on the ground and say, "hey, I am having a seizure" or other similar things. Many want drugs. Many want attention. It sounds to me as if she is faking it and most likely needs a psych eval.

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DocHarris
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Fri Mar 14, 2008 9:02 PM

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Ya I think one often overlooked aspect of "fake" seizures is despite the patient not having a physical reason for their seizure activity, the seizure itself is not necessarily voluntary. The catch-all nature of EMS and Emergency Rooms leaves us to clean up for untreated mental illness, which often makes us jaded to this misappropriation of resources. This person may using seizures as a coping mechanism to manipulate people around her, but it is doubtful she could just stop and consider it a "good run." While she may not have a neurological issue causing seizures, her potential mental illness is just as needing of professional attention and compassion. With the right help, she may be able to get her life back on track. As tempting as it is to walk away, and as frustrating as it may be to attempt to help her, you and your family are likely the key to helping her.

That is, if these are fake. I'm not a Doctor, and I'm definitely not a seizure expert. Even if I was I don't have any clinical information to base my judgement on.

I'm sorry to say that in the long run I think you'll find a seizure disorder would have been easier to deal with. Best of luck to you!

- Matt

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Cr20
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Wed Mar 19, 2008 4:32 PM

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Untrained people should not be trying to dx a fake vs true seizure. It is hard enough for trained medics/Dr/nurses to know and then sometimes you cant know. If you think your family member might be faking and delay medical tx and they are having a true seizure then the pt could suffer. There are people who fake seizures for attention, drugs or for whatever reason. Some are very good actors and know all the tricks. BUT, I would rather treat someone faking than withhold valium on a true seizure I thought was faking.

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DocHarris
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Wed Mar 19, 2008 4:48 PM

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Very good point Cr20. On ER rotation a few weeks back a patient with CHF who was rapidly worsening across the board starting shaking and making coughing noises. The nurse team leader kept talking to him "Larry. Come on take some deep breaths. Talk to me Larry." Neither of us realized for a good 10-15 seconds he was seizing. He kept seizing like that for a good 3-4 minutes until he Doc pushed (ohh... I could look this us but I'm going to test my Pharm memory. So correct me if this sounds wrong) medazolam and he calmed down. I've seen maybe a dozen different patients seize (not many, but I don't even have my new medic smell yet) and they've all looked different from the others to some extent.

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"A sucking chest wound is nature's way of telling you to slow down."

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jsadin
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Wed Mar 19, 2008 10:09 PM

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Midazolam. You were close.

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DocHarris
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Wed Mar 19, 2008 10:15 PM

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Atleast I was thinking about the right drug, even if I spelt it incorrectly. I wasn't sure I was even that close.

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"A sucking chest wound is nature's way of telling you to slow down."

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grambograham
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Wed Mar 19, 2008 11:24 PM

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Midazolam is known more commonly as Versed.

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If you can keep your head while all else around you are losing theirs'............................... You probably haven't checked with your answering service!

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roblanious
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Fri Mar 21, 2008 6:06 AM

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We carry versed, valium and ativan. Anyway, there are folks who are regulars and we know them well. We are not giving them anything but maybe a ride to the hospital with the nastiest nurses. I did an interfacility tranport between two neuro ICUs for a gentleman in his 40s or 50s who would have tonic-clonic activity, and yet remain conscious. He was initially thought to be faking it but later nobody knew what was happening. One nurse at the receiving hospital said it was a rare form of myoclonic seizures, but even the MDs were perplexed. I never did find out what it was, but I did get to witness an episode enroute.

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Greatness is not standing above our fellows and ordering them around, it is standing with them and helping them to be all they can be.
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paradude
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Mon Mar 24, 2008 11:43 PM

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I'll weigh in here...

It sounds as though she is suffering from psychological issues with regard to needing an assurance of what she defines as love and attention from others as a pay off of sorts for faking one of these pseudo-seizures. For example, when she feels insecure, she will show out in this way, and get her pay off, making her feel (at least for an instant) that she is loved and cared for. This had caused a stunting of sorts in her emotional maturity. In effect, she hasn't learned to feel secure in herself, and relies instead on these tantrums to fill that hole in herself. In other words..... NEEDY.

As long as her mother, or other friends or family members will give her this pay off, there is absolutely nothing you can do.

Sadly, that is just my "horse-sense" explanation, but not necessarily any type of a solution. It appears that you will never get through to your cousin, until you get through to those who would give her this pay off.

Without going into the medical causes and effects of seizures in general, I think this is more what you may be after.

-Paradude-

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The Paradude Creed: We should all work together to protect our young from being eaten...

Edited: Mon Mar 24, 2008 at 11:45 PM by paradude

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iamkate
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Tue Mar 25, 2008 8:49 AM

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whoa, Paradude..... you might just be the next "Dr. Phil"..... ;-)

Divamom... just get it over with and tell her that you think she might be faking and that she can get help in other ways.

Tink

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Edited: Tue Mar 25, 2008 at 8:49 AM by iamkate

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Lucid
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Wed Mar 26, 2008 10:11 PM

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Originally posted by: PARAMEDICMIKE


With all due respect, doesn't this sum up how you should be handling this situation?

For what it's worth, we are a group of prehospital providers. Granted, there are several on here who are exceptionally educated and experienced. However, we're not doctors. Nor are we capable of confirming or disproving a "diagnosis" based on the second hand account of someone who refuses to get wrapped up in it.

Family members who vie for attention can do so in many ways. We may even suspect that their actions (e.g. temper tantrum = seizure) may be psychological in nature. You said she's seeing a doctor extremely regularly. What more would you like to see happen?

Good luck to you.

-be safe



I want to reiterate this point, and I don't see why you find it condescending. It's the truth. Even if you went to a message board for neurologists, they would not be in a position to decide whether or not your cousin is faking seizures. It's impossible to make anything resembling an informed opinion on this matter because the only information available comes from a biased third party. There's no physical exam or test results to review.

Even if the paramedics/EMTs could meet your cousin, get her side of the story, watch her have a "seizure", assess her, etc they would not be qualified to "diagnose" your cousin with seizure disorder or lack thereof. That's not really within our scope of practice as prehospital care providers.

I hope you don't find this condescending or anything, I just want you to realize that in such a serious situation this isn't the best place to be seeking advice. Perhaps you can contact her doctor and express your concerns. You may very well be correct and by taking action you may be able to help your cousin go down the right path and get the help she needs.

I wish you and your family the best and I hope all of you can pull out of this stressful situation.

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roblanious
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Fri Apr 04, 2008 3:51 AM

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I remember back in the 80s and early 90s how we would never be able to diagnose MIs or determine the cause of unresponsiveness despite the constricted pupils and needle next to their arm. I we would not be able to determine if someone was having a stroke. We could not possibly determine if someone is dead or ever pronounce one dead, let alone cease resuscitation efforts. Funny, now it is common practice to pronounce and cardiac arrest patients are rarely transported now because we now call it in the field. I bet most medics today don't even remember the days we transported cardiac arrest patients routinely.
I can say with absolute assurance, there are patients I see routinely that I KNOW they are faking and whent they get into the ED, the triage nurse or attending tells them so as well. It's funny to watch some of them just get up and walk out the door. And with just some basic assessment skils I can determine if someone is faking a seizure or a syncopal episode, and after almost 20 years, I have not been wrong yet (and I seem to be wrong on everything else-just ask my wife).

Oh, Paradude, I wish I could have said it like you. I actually think you nailed it.

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divamom
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Thank you all for your replies. I do realize that no one here can diagnose my Cousin just based on my description and or own opinion. I was online looking for a message board site where I could ask a question of someone in the medical field and this was the only one I could find. I hold the highest respect for all of you in your field. Thanks again.

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Eydawn
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All I can offer is sympathy... and join the "paramedicmike wasn't being nasty" trend...

Unless you can convince your relative to seek psychological evaluation, all you can do is *not* respond to the drama. Faking seizures like this, with a diagnosis of a true seizure disorder, has been referred to in one of my fields as "pseudoseizures" (I speak not of prehospital EMS, but the Developmental Disabilities direct care world). Timed to gain attention, reinforced by receiving attention, and a damned nuisance to everyone... this person is seeking attention, and obviously seems to have some hypochondriac tendencies.

And to echo paramedicmike... no, there is nothing you can do about your pain in the arse cousin. There's no good advice we can really give you, either. Distance yourself, and hope your relatives figure out that not giving attention to it will decrease the frequency (or drive her to the point where her mental problems are acted out in a more significant way that may be the impetus to her getting specific treatment for them).

Good luck! Sorry, I know it's a sucky position to be in... but Mike's right. Strange EMT's on a forum are not the best folks to ask. You might consider asking a psychologist or similar about your cousin's behavior... because this might be more of a mental issue than a medical one. Not a bad idea to go look for advice... but simply the wrong venue!

Wendy
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There's a fine line between genius and insanity- Guess which side I'm on! (My father)

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grambograham
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The med you mentioned in your first post is neurontin. It is a med commonly used to help with seizure control in adults and children as well as being used as a adjunct for pain relief of nerve pain.

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If you can keep your head while all else around you are losing theirs'............................... You probably haven't checked with your answering service!

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simonsez
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Originally posted by: roblanious
I would like to add to what has been said already that we see pseudo-seizures on a common basis in the ED. These are seizures based upon a psych issue, often called fake seizures. If is sometimes comical as some will shake around on the ground and say, "hey, I am having a seizure" or other similar things. Many want drugs. Many want attention. It sounds to me as if she is faking it and most likely needs a psych eval.


Glad you find psuedoseizures so amusing. The term is not actually used by neurologists to describe "fake" seizures, rather, non-epileptic seizures. I have been a paramedic for over 18 years and have no reason to fake a seizure. However, I recently started having them after a head injury. A know it all doctor and his staff took it upon himself to decide I was faking or as he called it, a "psuedoseizure" and gave me no treatment at all despite my dilantin level being only 3. He moved me to the ER obs area, and about an hour later, I went into status epilepticus and was rushed to the ICU and intubated for five days. When I initially came around after the first round of seizures, he was literally poking me in the face under my eye and telling me to knock it off and quit faking. EMS were the only people who gave me any treatment prior to the ER, and I got none from this doctor who thought he knew it all. Thanks to him I was on life support for several days and could have potentially died had he just sent me home. Since we were in the middle of a hurricane, he couldn't send me home, but told me that if I "insisted" I was having seizures, I needed to stay. Needless to say, the neurology team who followed me at that hospital was not happy with his inaccurate diagnosis of faking and the loose use of the term pseudoseizure. I really wish Doctors and Nurses would learn the use of the term if they are going to throw it out there at patients.

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roblanious
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Sorry that you had such a bad experience but we have a very busy ED and often get pseudoseizures. Sometimes they are funny, but when we are busy they become an obstical to treating our seriously ill and injured patients. I feel bad that your seizure was misdiagnosed and studies have shown that many healthcare providers easily misdiagnose them, sometimes up to 60%. That is why in our ED, unless the person is saying "I am having a seizure" or something just as comical, if we don't know the patient or don't have a history of them, we assume they are legit until proven otherwise. I will admit, there are probably rare cases where people with seizure disorders also have pseudoseizures, complicating things. I no hardly anything about you but I can only assume this applies to you.

Your definition of a pseudoseizure seems to be a little incorrect. The definition you gave is more like a Paroxysmal nonepileptic episode. According to an online medical dictionary, Pseudo means "false". According to the same medical dictionary, pnedoseizure is listed as a Psychogenic seizure, A clinical spell that resembles an epileptic seizure, but is not due to epilepsy. The EEG is normal during an attack, and the behaviour is often related to psychiatric disturbance, such as a conversion disorder.
To learn about the psychosocial etiology of pseudoseizures, look here, and here is another good e-medicine article on pseudoseizures.
If you had a seizure as a result of a head injury, calling it a pseudoseizure would be inappropriate. 5-10% of TBI cases result in seizures, about 30% being generalized, while most are focal or complex partials. This article covers a method of terminology and so much more regarding post-traumatic seizures.

If you are on dilantin that probably means you have a seizure disorder, then the ED MD should have assumed yours was legit. Unless he saw or knew something we are not aware of, he massively goofed and I wonder if you don't have grounds for a lawsuit. I must assume you are going that route.


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Greatness is not standing above our fellows and ordering them around, it is standing with them and helping them to be all they can be.
G.Arthur Keough (1909-1989) Educator

Edited: Mon Sep 22, 2008 at 4:33 AM by roblanious

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Cr20
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Being an 18 year paramedic you cant tell me you have never seen a pseudoseizure. If you havent then you call volume must have been nil. Pseudoseizures are common to EMS for reasons already listed. And some are comical as stated. When you have someone with consistent movements and you can give them a command and they obey to get their drug then they are faking. No one here said that medic, nurses and doctors are perfect at making a dx between pseudoseizures and a real seizure. As said before some are very good actors. But not all are perfect. I also find it hard to believe that if the ED knew you were are dilantin they did not do a level check. That is as automatic as the ED asking for your insurance cards.

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roblanious
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Well dilantin levels take awhile, depending on the expediancy of the lab. In the meantime, the patient is still seizing. Either the MD there did not know the patient in this situation, or there are parts of the story we are not being told. I too am suspicious of an 18 year veteran paramedic who cannot properly define "pseudoseizure", but I will have to assume that her experience was genuine.

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Cr20
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Correct. You are not going to with hold meds waiting on Dilantin Levels. I was just saying at all the EDs I have been in and that is one of the first things the Doc orders is that persons levels. But mistakes do happen so I guess they could have forgotten. But there is always that case of a hard nose know it all Doc that may be head set on a person faking and says I am not wasting my time drawing labs. But then most Docs go overboard to CYA.

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simonsez
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Be suspicious of an 18-year veteran all you want, but yes, I have seen my share of fake seizures. I never said I haven't. My issue is the use of the term everyone feels they know so well. I am equally suspicious of people who don't know they difference between a seizure, pseudoseizure (or psychogenci seizure if you wish to go that route), and a fake seizure. My call volume was extremely high thank you very much, as I live and work in the third largest city in the US. However, we don't refer to them as pseudoseizures, just plain faking. Even if a psychogenic seizure is a result of stress or other pyschological disorder, that does not mean it is a fake seizure. It is just that, a pseudoseizure. It is still the brain sending erratic impulses within the brain. Similar to the term pseudo tumor cerebri, which is not an actual tumor of the brain, but causes intercranial hypertension and all the same symptoms of a brain tumor. Those people are not faking. I just feel we are taking the use of the term pseudoseizure vs a fake seizure a little far. I think too many people lump faking into the category of pseudoseizure, as it is still a seizure just of a different cause. Yes, there are the standouts in the acting category, and I agree a faker can be comical. I just don't like them all being lumped into the category of a pseudoseizure. My point was, that I have epileptic seizures and am on medication for it, but the doctor took it upon himself to decide I was faking a called it a pseudoseizure in addition to saying I was faking. Thanks to his holier than thou attitude, I could have been out of the hospital in less than a day, and stayed 2 weeks trying to get my med levels correct. The only part I left out was that they had to try so hard to get me to stop seizing that I was overdosed on dilantin. A dilantin level of over 50 was not a pleasant feeling after the OD'd me. It's one thing not to treat the obvious fake, but in any questionable situation, you should go ahead and treat. We do have a duty to act. And yes, I am going the malpractice route.

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simonsez
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Oh, and Cr20, if you read the post carefully, I never said they did not check my dilantin level. I said it was three and he did nothing about it. It wasn't handled until the ICU when I ended up on the vent. Guess my "performance" wasn't up to standard for the doctor.

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TomB
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Just my opinion, but I don't think it's out job to determine whether or not a patient is faking a seizure. It's our job to determine whether or not a patient is medically stable. Hitting them in the face with their own hand, giving them the ammonia inhalant "tusks", poking them in the eye, knocking between their eyes with the reflex hammer, and other forms of mean spirited behavior violate the first rule of medicine, which is "do no harm". Not to mention, you might be wrong, and the patient might be conscious of the fact that you are mocking them while they are having a seizure, as has been tragically pointed out already in this thread. In my mind, this is completely unacceptable, as only someone who has lived through such an experience can really explain (and I appreciate you sharing that with us). I know urban EMS is difficult, and you see a lot of quacks, fakers, and frequent fliers. I'm not saying it's easy to stay professional 100% of the time, but mistakes carry consequences for innocent people. Keep that in mind. We take care of people who can't take care of themselves. It's easy to forget what an awesome responsibility that is.

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roblanious
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I love this.. This is so typical in our ED, and probably everyone elses!

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Greatness is not standing above our fellows and ordering them around, it is standing with them and helping them to be all they can be.
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HEWITTC4
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Originally posted by: roblanious
I love this.. This is so typical in our ED, and probably everyone elses!


Did you notice that in your video of a crazy women, the top "related video" listed is a Lady Gaga video?

Also, was it just me or did the ER look more like a convenience store?

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Murphy was an optimist.

Edited: Thu Jan 14, 2010 at 11:44 PM by HEWITTC4

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