Pseudoseizures

So in this George Orwell-1984-world, where we can't call a spade a spade, we have such a thing as pseudoseizures. Pseudoseizures are when the patient is faking seizures, for whatever reason, but of course there is no ICD-9 code for "fake seizures," and we therefore can't bill for it, so we call it "pseudoseizures" which DOES have an ICD-9 code, and makes everybody happy. In the medicine world, for whatever reason, when someone is faking something (be it consciously or subconsciously) it is a rule never to confront them about it, because the story goes that your confronting them just might push them over whatever edge they are teetering on at the moment.

I am not sure I buy that.

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Last night I admitted a patient that was doing perhaps the worst impersonation of seizures ever. Here are some rules about seizures:

1. If it's a real seizure, the patient loses control of their bladder and/or bowels. Since people tend not to like to wet/soil themselves, the fact that a patient (and I'm sorry to say it, but it's almost invariably a female) stays continent throughout a "seizure" is one of your first clues that it's fake. My patient stayed continent.

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2. A seizure is an area in the brain where neurons are firing like crazy, and one of the signs is that the patient's eyes deviate together toward the focus (area) of the seizure....My patient kept her eyes open, blinked them like a normal conscious person, and looked around the room.

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3. One of the medications we use to stop a seizure, Valium, take at LEAST a few minutes to work. Upon being given 5ml normal saline (i.e. salt water), my patient promptly "woke up."

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4. After a patient has a seizure, they are post-ictal (just means "post-seizure") for usually 30-60 minutes, if not more. Basically they are really groggy, and can't really talk or answer questions. My patient had no post-ictal period at all. She would stop rocking (also a good sign it's not a real seizure) and within 15-20 seconds be fully alert.

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Unfortunately, most of the people who come in with things like this have some reason to want to stay in the hospital, as I suspect this patient has. It would be much simpler for all of us (not to mention it would get me to the gym and/or Panera that much faster) if they found some other way of letting their stress out....

So there is your 5-minute tutorial about seizures vs. pseudoseizures.

Test on Friday. Just kidding!