Nursestories

Posted on April 18 , 2010

Psychosomatic Seizures rss

It wasn’t the first time that I was witnessing a “fake seizure” at the ED, but it was overwhelming to see how the patient was completely and utterly under her own spell. In her mind, she was having a real seizure with all the symptoms relating to it.

This young twenty something year old girl was transferred to us for a neurology consult following a seizure she had at home. She was already taking epileptic medication in which her level was normal, and her ct-head and EEG results were negative. She and her mother also had a history of psychiatric issues which led to the hypothesis that her recurrent seizure was self provoked. It seemed she was having an argument with her mother prior to her convulsion when it happened. Speaking with the patient made me doubt any presence of ulterior motives. She answered the questions correctly, a little too correctly mind you for someone who was suppose to be in postictal. Neurology finally signed off saying there were no neurological deficits or neurological induced activity causing the seizures. So we finally decided to discharge the patient back home and that’s when the Grand Mal seizure occurred. Like a synchronized time bomb. Obviously the patient wasn’t planning on leaving just yet and performed a 15 minute full body tremor scene. Her jaw wasn’t clenched, her limbs weren’t stiff, didn’t bit her tongue, wasn’t over-producing any saliva, and wasn’t snoring or acting confused after the supposed seizure. She was just sleeping calmly. And surprisingly enough, she wasn’t responding to pain at all. Her vital signs were normal and her airway intact, so I wasn’t worried about the fact that she wasn’t waking up. We then asked for a psych consult but the psychiatrist couldn’t assess the patient until she was widely awake.

But how do you treat someone who is convinced of having a seizure and is genuinely not doing it on purpose. “That’s the fun part.” the psychiatrist said. “It will take a long time to help the patient figure out the origin of her behavior and have some sort of control over it.” Way too abstract for me. I prefer a real seizure provoked by a real illness that can be controlled with real medication. It makes the problem easier to solve.

Posted by: RN13 0 comments