# Psychogenic nonepileptic seizures



## NomadicMedic (Apr 19, 2011)

I'm curious how other medics treat psychogenic nonepileptic seizures or "pseudoseizures". 

As some background, Psychogenic nonepileptic seizures (PNES), or pseudoseizures are paroxysmal episodes that resemble and often misdiagnosed as epileptic seizures; however, PNES are psychological (ie, emotional, stress-related) in origin. 

I've found that ED staff is not very tolerant of these patients, as they all seem to think the PT is faking the seizure activity, beacuse there is no postictal period, the patient doen't have a seizure history, isn't on antiseizure meds or admits to pseudoseizures.

Anyone have experience with this?


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## NomadicMedic (Apr 19, 2011)

I ask because I had a patient this weekend, found in seizure on the kitchen floor. Her husband told me she has a history of pseudoseizures and conversion disorder. I'm not a mental health professional, nor am I going to try to differentiate between and epeleptic and non-epileptic seizure in the field. My only option was to get the patient into the back of my medic unit, try and reduce her anxiety and treat her with some benzos. As I mentioned above, there was no postictal period. When the seizure activity ended, she was lucid, and did not want to be transported to the hospital because she was tired of being labeled a "faker and drug seeker".

It was a confusing and, after hearing her history, sad case...


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## Veneficus (Apr 19, 2011)

n7lxi said:


> I ask because I had a patient this weekend, found in seizure on the kitchen floor. Her husband told me she has a history of pseudoseizures and conversion disorder. I'm not a mental health professional, nor am I going to try to differentiate between and epeleptic and non-epileptic seizure in the field. My only option was to get the patient into the back of my medic unit, try and reduce her anxiety and treat her with some benzos. As I mentioned above, there was no postictal period. When the seizure activity ended, she was lucid, *and did not want to be transported to the hospital because she was tired of being labeled a "faker and drug seeker".*
> It was a confusing and, after hearing her history, sad case...



Poor medicine, no other explanation unless she is a drug seeker.


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## NomadicMedic (Apr 19, 2011)

Veneficus said:


> Poor medicine, no other explanation unless she is a drug seeker.



I don't understand... My treating the patient was poor medicine, or the hospital had been treating her poorly?

When I arrived at the ED with the PT, the RN rolled his eyes after I filled him in on the situation and history. But, faking or not, *I'm* going to treat the patient with compassion, kindness and respect.


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## Aidey (Apr 19, 2011)

In my limited experience I think these patients frustrate the hospitals because there is pretty much nothing they can do but watch them and send them home with xanax (or whatever) and a referral to psych. EDs do not like patients who use them for management of a chronic condition on a regular basis.

Imagine if you had a diabetic, who rather than giving themselves insulin, waited till their blood sugar was high enough and then went to the ED for their insulin. Or a patient with depression that goes to the ED when they want to talk to someone rather than make regular appointments with a counselor. 

There is also the fact that there is still a bias in healthcare asa whole about psych patients. 

Something I have run into are people with psychogenic seizures who do not understand their disorder at all, which really complicates the situation.


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## mycrofft (Apr 19, 2011)

*IF you consider Munchhauisen's an illness, many more are sick.*

The perceived necessity to lie or prevaricate to get attention and care can be either emotional insecurity, psychatric or psychological illness, or something of them all. This can include a partner who reports then participates in the whole shebang

This is not including those who pragmatically do it to get drugs of abuse.

ER and all medical staff just get tired of people lying to them and non-postictal seizures look like lying.

Differential: if someone has a full blown funky chicken grand mal, they are going to be postictal, not neccesarily incontinent, and may show signs of trauma from unguarded falling or biting inside of mouth. Postictal means out of it, no resisting eyelid lifting, no holding their breath when they hear the ammonia "pop", no smiling, no cracking open eyelids to peek around. I personally know individuals for whom the sternal rub is a joke.

Absence seizures or petite mal with very limited epileptiform activity can conceiveably not always have a postictal state beyoind having "lost" the period of time their brain was otherwise occupied.

I am *convinced* that people reporting grand mal without postictal were "had" by a false seizure but working in good faith based on trusting the pt explicitly.

Follow your protocols and treat em fairly and honsetly , you may avoid undertreating someone who needs it, and fakers or Munchausen victims will sue you, in fact, may set traps to get witnesses see you non-treating them


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## Melbourne MICA (Apr 20, 2011)

*In control*

I think we've all had this kind of patient at least once in our careers and what can you do? Treat all patients with respect, courtesy and kindness, definitely.
As for how you treat if at all - you have to make some form of clinical judgement. If they don't need interventions then they don't need interventions. Transport may well be mandated if for no other reason than to cover your butt. If ED staff want to scoff and roll their eyes then you can ask them what they would do in your shoes with your limitations and imposed directives.

As for picking the seizure faker I agree with mycroft - there are physiological signs that come with generalised seizures as well as general principles you can apply to make the assessment more accurate.

One principle I use is to look for voluntary muscle control. In a generalised seizure - ie one involving the whole brain the motor cortex is disabled. So the patient CANNOT have voluntary muscle movements and both sides are affected at the same time. 

So I look for them if the situation looks suspect - eg normal obs, no tachy, no sweating or hot skin, no wrist flexion, no Phx or meds, no head trauma or drugs involved, they hold a limb on one side in one position while the other is doing something different etc.

Doesn't always work but works often enough. The attention seeker wants attention. Walk out of the room, pack up your gear but have one observer handy to sneak a peak around a corner. And if the seizure is legit you still won't compromise the pt if the obs were good to start with by walking out for a few minutes.

MM


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## Veneficus (Apr 20, 2011)

n7lxi said:


> I don't understand... My treating the patient was poor medicine, or the hospital had been treating her poorly?
> 
> When I arrived at the ED with the PT, the RN rolled his eyes after I filled him in on the situation and history. But, faking or not, *I'm* going to treat the patient with compassion, kindness and respect.



I meant the hospital was practicing poor medicine. Sorry for the confusion.


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## ExpatMedic0 (Apr 20, 2011)

I had a patient we went on regularly that sounds just like yours. However whenever I got them loaded into the ambulance they always stopped, every time. The hospital would always be irritated when I should up with the patient.


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## OrlMedic3388 (Apr 20, 2011)

I have several patients where I work that have pseudoseizures.  I was told by a doctor in one of the hospitals that if in fact it is a pseudoseizures, you can verbally control the patients "seizure."  Next time you encounter them trying telling them to stop doing what they are doing.  The doctor said to use a loud voice (not yelling though) and tell them to stop.  Obviously if it is a real seizre this wont work.  I have seen this work on two different patients.


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## medicsb (Apr 20, 2011)

Where I worked, I encountered enough people faking seizures and unconsciousness that it was at the top of my differential.  But, these weren't people diagnosed with severe psychological disorders such as conversion disorder.  For her to have actually been diagnosed with conversion disorder suggests that she got an intense work-up from neurologists and psychiatrist, likely included an EEG that was negative for seizure despite what appeared to be seizure activity.  She wasn't faking, per se, though.  Part of the premise of conversion disorder is that the patient is not consciously producing the symptoms, thus it could be impossible to tell the difference without a known history of conversion disorder with seizures/convulsions.

Anyhow, where I worked, these patients (fakers) were generally triaged to BLS.  Febrile SZ with antipyretic given prior to arrival and any patient not post-ictal with a history of seizures were often triaged to BLS.    (Only done after a thorough H&P, etc.)

To be sure I have seen a few seizures that were not followed post-ictal states such as partial and complex partial seizures.


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## Dada Simba Detuned (Feb 17, 2013)

*Wow... some of you really need to educate yourselves a bit!*

As someone who has been diagnosed and dealing with PNES for over two years, I am shocked that so many of you have the gall to judge these patients when you haven't fully educated yourselves. Try to exercise a little bit of compassion and when you have a few minutes (do your job and) read this: [this chat board will not allow me to include the link because I am a new user]. I can assure you that when I am transported by ambulance to an ED it is NOT what I want to be doing or where I want to be, and "telling me to cut it out" is not going to help me control my behavior. I am a sexual trauma survivor who has a REAL condition that is NOT malingering or drug or attention seeking... I'm actually benzo intolerant and more often than not have a paradoxical reaction to any benzos or sedation. Stop judging and try to exercise a little compassion while doing your job! And don't ever come to my aid during a seizure where I am (involuntarily) slamming my head against a concrete patio... because if you start telling me to "cut it out" I'll probably give you reason to "Section 12" me (in MA)!


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## STXmedic (Feb 17, 2013)




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## Dada Simba Detuned (Feb 17, 2013)

*Not sure I understand what your image is intended to convey...*

Could you "enlighten" me?


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## VFlutter (Feb 17, 2013)

Dada Simba Detuned said:


> Could you "enlighten" me?



Your first post was very confrontational. I understand your frustrations but I think you could have eased you way into it as a new member on this forum. The picture is anticipating that your post will "stir the pot" and get some equally aggressive responses. 




Dada Simba Detuned said:


> As someone who has been diagnosed and dealing with PNES for over two years, I am shocked that so many of you have the gall to judge these patients when you haven't fully educated yourselves.



I do not think any of us are trying to discredit true PNES but the fact is that the condition is extremely rare and far out numbered by people who intentionally fake seizures. It is truly unfortunate that we most often assume a person to be faking but it is hard not to when 99 times out of 100 it is the case.


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## JPINFV (Feb 18, 2013)

Dada Simba Detuned said:


> [righteous indignation]




Here's the problem. Generalizing a bit, there are three different types of "seizures." Real seizures, psychogenic seizures (seizure like activity without EEG change, but not in control of the patient), and malingering seizures ("fakers" looking for some sort of external benefit). Unfortunately, from a "The patient is seizing right now and we have nothing to go off of besides a history and physical," the psychogenic and the malingering seizures are going to look pretty similar.


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## Dada Simba Detuned (Feb 18, 2013)

*Thank you Chase*

For clarifying the intent of the post with the picture. I am sorry if my posts seem confrontational. I am a health provider, but also a peer advocate for PTSD patients. I have personally experienced and witnessed EMTs (but more often other medical personnel) re-traumatize trauma patients with this notion that we are "faking it" or can just somehow "snap out of it" if a provider yells at us and (further) scares us enough. Many of the EMTs in Boston with whom I have worked professionally in the past are VERY compassionate when transporting me... but in many cases it's because they know me professionally before I became their patient. So... yes... I am a bit frustrated I guess. My intent IS to get attention... so that folks will take a few minutes to think about their assumptions and how they may actually be harming patients with their actions and behavior. If I need to be "confrontational" in order to get someone's attention (as long as I'm not so much so that they shut down and don't listen)... so be it. Thanks for your insight/reply.


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## Dada Simba Detuned (Feb 18, 2013)

Dada Simba Detuned said:


> For clarifying the intent of the post with the picture. I am sorry if my posts seem confrontational. I am a health provider, but also a peer advocate for PTSD patients. I have personally experienced and witnessed EMTs (but more often other medical personnel) re-traumatize trauma patients with this notion that we are "faking it" or can just somehow "snap out of it" if a provider yells at us and (further) scares us enough. Many of the EMTs in Boston with whom I have worked professionally in the past are VERY compassionate when transporting me... but in many cases it's because they know me professionally before I became their patient. So... yes... I am a bit frustrated I guess. My intent IS to get attention... so that folks will take a few minutes to think about their assumptions and how they may actually be harming patients with their actions and behavior. If I need to be "confrontational" in order to get someone's attention (as long as I'm not so much so that they shut down and don't listen)... so be it. Thanks for your insight/reply.


Could someone explain to me why I have just been "blocked" for not following a rule that was impossible for me to follow?


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## Dada Simba Detuned (Feb 18, 2013)

Dada Simba Detuned said:


> Could someone explain to me why I have just been "blocked" for not following a rule that was impossible for me to follow?


I tried to post a hyperlink many times, and once the system finally did let me do so, I now find that I have been "blocked" by the moderator from any additional posts. I guess you folks aren't really all that interested in learning about PNES. Be well...


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## STXmedic (Feb 18, 2013)

It's not impossible. She provide the information you were required to put. You didn't put it. She removed the quoted information. Repost it with the appropriate required information and I doubt there would be a problem.


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## STXmedic (Feb 18, 2013)

Dada Simba Detuned said:


> I tried to post a hyperlink many times, and once the system finally did let me do so, I now find that I have been "blocked" by the moderator from any additional posts. I guess you folks aren't really all that interested in learning about PNES. Be well...



Dude, you're posting. So obviously you can make additional posts.


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## mycrofft (Feb 18, 2013)

Dada Simba Detuned said:


> As someone who has been diagnosed and dealing with PNES for over two years, I am shocked that so many of you have the gall to judge these patients when you haven't fully educated yourselves. Try to exercise a little bit of compassion and when you have a few minutes (do your job and) read this: [this chat board will not allow me to include the link because I am a new user]. I can assure you that when I am transported by ambulance to an ED it is NOT what I want to be doing or where I want to be, and "telling me to cut it out" is not going to help me control my behavior. I am a sexual trauma survivor who has a REAL condition that is NOT malingering or drug or attention seeking... I'm actually benzo intolerant and more often than not have a paradoxical reaction to any benzos or sedation. Stop judging and try to exercise a little compassion while doing your job! And don't ever come to my aid during a seizure where I am (involuntarily) slamming my head against a concrete patio... because if you start telling me to "cut it out" I'll probably give you reason to "Section 12" me (in MA)!



OK, I get it. Yes, there are folks who have seizureform activity due to psychological factors which will be clinically confounding, not dissimilar to conversion disorder cases (formerly called "hysteric") of blindness and paraplegia or paresthesia. Benzo's wouldn't help except by "snowing" the pt and reducing anxiety...unless they have paradoxic response to benzo's, in which case it may be wasted.

Since they don't conform to clinical findings for a true clonic/tonic seizure, and meds don't help as they would in a tonic/clonic, they present clinically identical  to factitious seizures.

Maybe such patients need to carry a card or such from their practitioner to avoid being over treated by responders?

You must understand that there are SO MANY, many more factitious seizure patients, though, that the subject is a sore one for us and psychologically induced seizures are not a subject of protocol or teaching. Just as shouting at you will not make your seizureform activity go away, threatening and railing against the members of this forum will noit make us go away. Quite the opposite.

Thanks for the citation, I for one am interested. Did we miss the OP's point and get swung out on Munchausen's and factitious seizures prematurely?


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## Dada Simba Detuned (Feb 18, 2013)

Dada Simba Detuned said:


> I tried to post a hyperlink many times, and once the system finally did let me do so, I now find that I have been "blocked" by the moderator from any additional posts. I guess you folks aren't really all that interested in learning about PNES. Be well...


If you're going to put me on probation for not posting a hyperlink when the system was blocking me from posting hyperlinks (because I am a new user), then clearly no one wants to hear what I have to say here anyway. I wish you all the best, and I hope that none of you ever has to experience some one you care about being re-traumatized by a health care provider who has not educated themselves about PTSD and PNES. For those of you who do provide first responder care with compassion and professionalism, I sincerely thank you. Be well...


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## Dada Simba Detuned (Feb 18, 2013)

*The system will not allow me to do any of that...*

I was blocked and my hyperlink was deleted after I was finally able to post it.



PoeticInjustice said:


> It's not impossible. She provide the information you were required to put. You didn't put it. She removed the quoted information. Repost it with the appropriate required information and I doubt there would be a problem.


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## Aidey (Feb 18, 2013)

You haven't been blocked, and the rule wasn't impossible for you to follow. Just because you can't post the hyperlink does not mean you can't provide the other information needed to meet the Fair Use Principle. Copyright violations on forums have resulted in lawsuits before, and we aren't going to risk it.


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## Dada Simba Detuned (Feb 18, 2013)

*Please look at prevalence rates for PNES*

It is likely not as rare as you think. I do not deny that some folks are "faking it," but for those of us who are not... treating us that way can be potentially quite harmful. I can provide lots of information from the perspective of a patient advocate and substantial medical research if you are interested. But I have been censored on this board so I'm not that interested in wasting my time if my comments and citations are to be deleted (I have better things to do with my time). Please feel free to contact me via PM if you are actually interested in learning more about PNES, and it's connection to PTSD and in particular sexual trauma survivors. Thanks to those of you who DO do your job with compassion... be well... Simba



mycrofft said:


> OK, I get it. Yes, there are folks who have seizureform activity due to psychological factors which will be clinically confounding, not dissimilar to conversion disorder cases (formerly called "hysteric") of blindness and paraplegia or paresthesia. Benzo's wouldn't help except by "snowing" the pt and reducing anxiety...unless they have paradoxic response to benzo's, in which case it may be wasted.
> 
> Since they don't conform to clinical findings for a true clonic/tonic seizure, and meds don't help as they would in a tonic/clonic, they present clinically identical  to factitious seizures.
> 
> ...


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## JPINFV (Feb 18, 2013)

Aidey said:


> You haven't been blocked, and the rule wasn't impossible for you to follow. Just because you can't post the hyperlink does not mean you can't provide the other information needed to meet the Fair Use Principle. Copyright violations on forums have resulted in lawsuits before, and we aren't going to risk it.



To be fair, Righthaven got [female dog] slapped by the judges in cases that actually went to trial. So bad that they aren't even in existence any more.


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## Dada Simba Detuned (Feb 18, 2013)

My providers will not recommend carrying such a card because of potential liability... there is some co-morbidity with PNES and epileptic seizures and so the neither my neurologists or my psychiatrists are willing to provide any support for "labels" that my lead a provider to ignore what may be an actual epileptic seizure.


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## Aidey (Feb 18, 2013)

Yeah, but something tells me that Matt wouldn't even want it getting to the point a Judge is involved...


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## STXmedic (Feb 18, 2013)

Do you mean status epilepticus?...


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## Dada Simba Detuned (Feb 18, 2013)

*I intended to follow the rules, I am human*

You may already know that people with severe PTSD also have left frontal-lobe types of cognitive deficits/symptoms... so even though I likely am as "smart" as at least some of you, it is almost 1am where I live and it's a bit hard to figure this system out when you're almost 50 years old and have had multiple PNES in the last few days (some of which involved whacking me head on rather hard objects like ED floors)! So please forgive me if I'm a bit slow tonight 



JPINFV said:


> To be fair, Righthaven got [female dog] slapped by the judges in cases that actually went to trial. So bad that they aren't even in existence any more.


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## VFlutter (Feb 18, 2013)

Dada Simba Detuned said:


> I tried to post a hyperlink many times, and once the system finally did let me do so, I now find that I have been "blocked" by the moderator from any additional posts. I guess you folks aren't really all that interested in learning about PNES. Be well...





Dada Simba Detuned said:


> If you're going to put me on probation for not posting a hyperlink when the system was blocking me from posting hyperlinks (because I am a new user), then clearly no one wants to hear what I have to say here anyway. I wish you all the best, and I hope that none of you ever has to experience some one you care about being re-traumatized by a health care provider who has not educated themselves about PTSD and PNES. For those of you who do provide first responder care with compassion and professionalism, I sincerely thank you. Be well...



You can still post the link, not hyperlinked, and the required information. The rules have nothing with not wanting to hear what you have to say. I am sure if you published a paper or wrote an article you would expect the same professional respect. 

Please do not patronize us and act like we are all uneducated brutes who go around traumatizing patients. I can assure you that most of us on this website, including myself, are very educated and more than competent.

Righteous indignation was the perfect description....



Dada Simba Detuned said:


> so even though I likely am as "smart" as at least some of



I am sure you are. I can copy and paste like a champ too


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## Dada Simba Detuned (Feb 18, 2013)

*"dude" it was only letting me reply to existing posts until someone lifte the blosk*

and I'm a "chick" not a dude!


PoeticInjustice said:


> Dude, you're posting. So obviously you can make additional posts.


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## Aidey (Feb 18, 2013)

There was never a block on your account.


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## Dada Simba Detuned (Feb 18, 2013)

*Chase: I am sure that is true*

But I just spent 15 minutes posting a bunch of information along with citations, only to have it deleted and then I was blocked from posting until someone lifted that block a few minutes later. So.. either I am a COMPLETE tech moron (which is possible) or someone shut down my ability to post and then undid it. Which I took as a sign that it's not worth my time to continue here. As a health care provider myself, I choose to believe that MOST of you are compassionate and professional. All of your posts lead me to believe that you would absolutely be someone I would trust with myself or a loved one in a medical crisis... thanks for your thoughtful reply(ies). 



Chase said:


> You can still post the link, not hyperlinked, and the required information. The rules have nothing with not wanting to hear what you have to say. I am sure if you published a paper or wrote an article you would expect the same professional respect.
> 
> Please do not patronize us and act like we are all uneducated brutes who go around traumatizing patients. I can assure you that most of us on this website, including myself, are very educated and more than competent.
> 
> Righteous indignation was the perfect description....


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## JPINFV (Feb 18, 2013)

Dada Simba Detuned said:


> and I'm a "chick" not a dude!



There are no girls on the internet.

Therefore, evidence must be provided to the moderators.


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## Dada Simba Detuned (Feb 18, 2013)

*for those who are still interested in learning more about PNES*

Here is the link: http://emedicine.medscape.com/article/1184694-overview

Thanks for your interest and time, and for the care that you provide to those in need.

Be well, 
Simba


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## Dada Simba Detuned (Feb 18, 2013)

JPINFV said:


> There are no girls on the internet.
> 
> Therefore, evidence must be provided to the moderators.


I have no idea what that means (mebbe I'm just too old or dumb to get the joke)... but I assure you that I am female!


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## Aidey (Feb 18, 2013)

Look, as the CL who has been online I can assure you I did not block you from posting. I removed the posts that were a copyright violation and I explained to you privately that you were welcome to repost the information as long as you followed the Fair Use Principle. Your information was not cited properly per the Fair Use Principle which is why it was removed.


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## JPINFV (Feb 18, 2013)

Dada Simba Detuned said:


> I have no idea what that means (mebbe I'm just too old or dumb to get the joke)... but I assure you that I am female!




It was very tongue in cheek... and referencing the joke that there are no women on the internet. 


Also, any reason to post a link to that time sink TV Tropes is worth it.


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## Dada Simba Detuned (Feb 18, 2013)

*Well, when I tried to post the sytem told me I was no longer allowed access...*

for about five minutes after someone deleted all of the posts with the quotes and links in them... so maybe I'm just too dumb to use this board... :sad: 





Aidey said:


> There was never a block on your account.


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## bigbaldguy (Feb 18, 2013)

Dada Simba Detuned said:


> But I just spent 15 minutes posting a bunch of information along with citations, only to have it deleted and then I was blocked from posting until someone lifted that block a few minutes later. So.. either I am a COMPLETE tech moron (which is possible) or someone shut down my ability to post and then undid it. Which I took as a sign that it's not worth my time to continue here. As a health care provider myself, I choose to believe that MOST of you are compassionate and professional. All of your posts lead me to believe that you would absolutely be someone I would trust with myself or a loved one in a medical crisis... thanks for your thoughtful reply(ies).



There was no modification of your posting ability. One of your posts was minimally altered. While it was being altered it would have appeared missing.  Once the modification was finished it dropped back into view.


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## mycrofft (Feb 18, 2013)

I suggest a strong dose of "tincture of take a deep breath" and come back in the morning...Pacific Time.


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## Dada Simba Detuned (Feb 18, 2013)

*AI think that they are usually relatively easy to differentiate*

There are a number of tricks that diagnosticians use to DDx PNES versus epileptic seizures... there are also things that most people will not do voluntarily if they are "faking it." The issue (I believe) is that first responders often do not have the time or tools (or job responsibility) to figure it out... the most compassionate care I received generally assumes that I am having a legit PNES because I have told them I have that diagnosis... but both I and the first responders understand that unless they have an EEG and video camara and neuro specialist in their truck that an emergency transport isn't really the place and time for that exercise. So as long as I am oriented and coherent, they respect what I say like any other patient... when I am no longer able to control whacking my head against dangerous objects, they switch to "seizure care" mode and I don't get to ask them to follow my instructions/requests anymore :wacko:



JPINFV said:


> Here's the problem. Generalizing a bit, there are three different types of "seizures." Real seizures, psychogenic seizures (seizure like activity without EEG change, but not in control of the patient), and malingering seizures ("fakers" looking for some sort of external benefit). Unfortunately, from a "The patient is seizing right now and we have nothing to go off of besides a history and physical," the psychogenic and the malingering seizures are going to look pretty similar.


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## JPINFV (Feb 18, 2013)

Dada Simba Detuned said:


> There are a number of tricks that diagnosticians use to DDx PNES versus epileptic seizures... there are also things that most people will not do voluntarily if they are "faking it."


 ...and some of those things people with psychogenic seizures won't do either. Not to mention that not all genuine seizures are the same (absence vs cluster (and simple vs complex) vs generalized).

However, since ambulances don't come with EEGs (the 60 cycling alone would make them useless), there's really no definitive way to declare a pseudoseizure a pseudoseizure unless the patient popped out of it and said, "I suffer from pseudoseizures."


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## Dada Simba Detuned (Feb 18, 2013)

bigbaldguy said:


> There was no modification of your posting ability. One of your posts was minimally altered. While it was being altered it would have appeared missing.  Once the modification was finished it dropped back into view.


Then I guess I'm just too dense and too tired to understand the messages from your system, because I'm fairly sure it said something along the lines of "You do not have access to this {something or other}"... mea culpa


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## Aidey (Feb 18, 2013)

If you were trying to access one of your posts that was moved that will happen. It doesn't mean you were blocked from posting, just that you no longer were able to see what you were trying to see.


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## Dada Simba Detuned (Feb 18, 2013)

*Well...*

... both deep breaths and tinctures (properly administered) can be quite useful in managing the symptoms of PNES... but I'm not sure they'll help me be less of a online posting board confusing messages moron 


mycrofft said:


> I suggest a strong dose of "tincture of take a deep breath" and come back in the morning...Pacific Time.


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## Dada Simba Detuned (Feb 18, 2013)

Aidey said:


> If you were trying to access one of your posts that was moved that will happen. It doesn't mean you were blocked from posting, just that you no longer were able to see what you were trying to see.


That's helpful to know thanks... I have cognitive deficits (from the benzos that are often inappropriately administered to me and from the PTSD symptoms) so it's often very confusing for me when stuff just says I can't access it and doesn't explain why... OR I could just blame it on being old


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## Dada Simba Detuned (Feb 18, 2013)

JPINFV said:


> ...and some of those things people with psychogenic seizures won't do either. Not to mention that not all genuine seizures are the same (absence vs cluster (and simple vs complex) vs generalized).
> 
> However, since ambulances don't come with EEGs (the 60 cycling alone would make them useless), there's really no definitive way to declare a pseudoseizure a pseudoseizure unless the patient popped out of it and said, "I suffer from pseudoseizures."


Agreed! Which is why I think the most respectful and medically appropriate approach is to treat all seizures like seizures... with the same protocols... because whether it's a legit PNES or epileptic seizure the recommended protocol is the same. But just because someone doesn't appear to be having a "stereotypical" seizure with post-ictal symptoms does not mean they are "faking it" or can control their involuntary motor responses to stimuli like flashing lights, loud unexpected noises, involuntary restraints, etc. In the interest of first responder and patient safety, as well as respecting the patients... I suggest starting out by ASSUMING that the seizures are legit until you have a good (educated perspective) reason to believe otherwise.


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## Dada Simba Detuned (Feb 18, 2013)

Dada Simba Detuned said:


> Agreed! Which is why I think the most respectful and medically appropriate approach is to treat all seizures like seizures... with the same protocols... because whether it's a legit PNES or epileptic seizure the recommended protocol is the same. But just because someone doesn't appear to be having a "stereotypical" seizure with post-ictal symptoms does not mean they are "faking it" or can control their involuntary motor responses to stimuli like flashing lights, loud unexpected noises, involuntary restraints, etc. In the interest of first responder and patient safety, as well as respecting the patients... I suggest starting out by ASSUMING that the seizures are legit until you have a good (educated perspective) reason to believe otherwise.


P.S. When I tell some first responders that I have been diagnosed with PNES, they look at me like I am "cray cray" and treat me like an attention seeking or drug seeking I don't know what... UNTIL I start seizing tonic-clonic style and then they get nervous and don't know how to react because they then think I'm having a drug withdrawal or epileptic seizure!


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## Dada Simba Detuned (Feb 18, 2013)

Aidey said:


> Look, as the CL who has been online I can assure you I did not block you from posting. I removed the posts that were a copyright violation and I explained to you privately that you were welcome to repost the information as long as you followed the Fair Use Principle. Your information was not cited properly per the Fair Use Principle which is why it was removed.


There is a delay between my attempting to post and/or post and when your messages come through. I am fairly tech savvy but it is extremely confusing to be unable to access prior messages and post new messages at the same time you are posting that I will be moderated or my message deleted for not following the rules. I apologize for not following the rules, but I was trying... and it's not that clear how and why the system is blocking you when it does. Please feel free to remove ALL of my posting referencing being blocked if you'd like (because I cannot figure out how to do it myself)! - book smart but obviously chat board dumb Simba


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## mycrofft (Feb 18, 2013)

Come back tomorrow morning.


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## Dada Simba Detuned (Feb 18, 2013)

*In case anyone is interested...*

The whole reason I posted here was because I came here to read your thread after reading this:

"The topic for this month’s post came to me after finding a thread of comments made by emergency medical professionals (EMPs) about psychogenic non epileptic seizures (http://www.emtlife.com/showthread.php?p=299085).  It was saddening to read how EMPs talked about how they are often berated by hospital staff for bringing in patients with non epileptic seizures. I hope reading this moves you to want to do something about it.

Psychogenic non epileptic seizures are a psychological condition.  Early trauma sets in motion a lot of secondary problems.  Self preservation activates defense mechanisms.  Maybe not the best ones, but when you are being traumatized, they may be the only ones you have.  Depression, anxiety disorders, post traumatic stress often co-exist with the psychogenic seizures.  

There is nothing laughable about the condition.  There is no shame in it.  And most importantly, the person who carries it suffers deeply.  After years of working with patients who have PNES, I have no doubt that there is nothing that most patients want than to get better.  So why is it that so many health professionals continue to look down on the patient?  Why are patients so often described as “fakers,” abusers of medical resources, and manipulators? Is it any wonder that patients try to hide the fact that their condition is psychological and not physical?    

I think a lot of what is fueling this is ignorance.  

How can we make it better?  If we stay quiet and allow it to go on, we allow retraumatization to go on.  I propose we do something to stop this. We need to become active in changing it. 

All those who come in contact with non-epileptic seizures  need to be educated.  After reading the thread above, I started working with an EMT professional to put together an educational program that we hope to take to around the state.  How about you?  What can you do to help produce change?"

 Text quoted in it's entirety from "The stigma of psychogenic non epileptic seizures (PNES) is still with us Posted by Lorna Myers on Jul 8th, 2011" on the PNES News page at http: // blog.nonepilepticseizures.com /


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## Dada Simba Detuned (Feb 18, 2013)

*Prevalence of PNES*

"As for psychogenic non-epileptic seizures, an article from the year 2000 by Benbadis and Hauser reported: “The prevalence of psychogenic non-epileptic seizures is somewhere between 1/50 000 and 1/3000, or 2 to 33 per 100 000.”" 

from "Psychogenic non-epileptic seizures: stigma and strength in numbers
Posted by Lorna Myers on Sep 24th, 2012" found at: http://blog.nonepilepticseizures.co...ptic-seizures-stigma-and-strength-in-numbers/




mycrofft said:


> OK, I get it. Yes, there are folks who have seizureform activity due to psychological factors which will be clinically confounding, not dissimilar to conversion disorder cases (formerly called "hysteric") of blindness and paraplegia or paresthesia. Benzo's wouldn't help except by "snowing" the pt and reducing anxiety...unless they have paradoxic response to benzo's, in which case it may be wasted.
> 
> Since they don't conform to clinical findings for a true clonic/tonic seizure, and meds don't help as they would in a tonic/clonic, they present clinically identical  to factitious seizures.
> 
> ...


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## Dada Simba Detuned (Feb 18, 2013)

*For those interested in learning (a lot) more about Dx and Tx for PNES...*

This is one of the more recent literature/research reviews on the topic(s):

Neuropsychiatr Dis Treat. 2012;8:585-98. doi: 10.2147/NDT.S32301. Epub 2012 Dec 10. Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium? Baslet G. Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

http://www.ncbi.nlm.nih.gov/pubmed/23251092


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## Dada Simba Detuned (Feb 18, 2013)

*A "lay user friendly" YouTube video re: PNES*

http://www.youtube.com/watch?v=3s5CN7_JROs


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## Clare (Feb 18, 2013)

If the seizure is severe enough then they'd get some intranasal midazolam from me, about the only thing we can do really, rest is up to hospital.  

By severe enough I mean if it was continuous and non-breaking or recurring and the patient was e.g. becoming hypoxic or significantly hyperthermic or something like that.

Very interesting.


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## Dada Simba Detuned (Feb 18, 2013)

*A lay version (with a better soundtrack)...*

http://www.youtube.com/watch?v=QWB0dq3RO3U

:rofl: (This is me PNES'ing... because it's not actually funny to those of us who live this experience on a regular basis.)

Be well, 
Simba


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## JPINFV (Feb 18, 2013)




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## STXmedic (Feb 18, 2013)

So... Do you remember these events in their entirety?...


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## NomadicMedic (Feb 18, 2013)

Following the "faking seizure" thread, I'm also going to close this thread.


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