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New Treatment for Pseudoseizures

Discussion in 'Emergency Medicine' started by southerndoc, 02.18.12.

  1. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor

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    I'm having great success with using Geodon for patients with pseudoseizures. Used it about ten times over the past few months for those patients. I'm seeing a lot of patients who can only take Dilaudid for their chronic pain have pseudoseizures when they find out they will not be getting their Dilaudid shot.

    Anyone else using mood stabilizers for those that like to fake their convulsions?
  2. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization

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    I prefer using normasaline.
  3. diphenyl

    diphenyl Dancing doctor

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    I used normasaline on a guy who kept yelling he was having a seizure while he was thrashing himself against the rails lol
  4. WilcoWorld

    WilcoWorld Senior Member

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    I use intranasal ammonia ampules supplemented with a non-rebreather mask. It's absolutely phenomenal at restoring purposeful movement - diagnostic and therapeutic.
  5. Muscletoe

    Muscletoe Do-gooder

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    Nasal trumpet.
  6. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    Perhaps this thread should me merged with the rectal exam one.
  7. myhandsarecold

    myhandsarecold

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    saaacurity!
  8. sacrament

    sacrament somewhere east

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    Makes sense. Improptu rectal exams are curative maneuevers for pseudoseizures, and are also helpful exercises for developing the physician's hand-eye coordination.
  9. NinerNiner999

    NinerNiner999 Senior Member

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    I have found that ordering a foley catheter is very successful.
  10. allendo

    allendo Senior Member

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    I rub lubricant on their forehead and tell them its a new transdermal seizure medicine, works every time.
  11. EctopicFetus

    EctopicFetus Keeping it funky enough

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    If my pseudoseizure patient is a woman, I give then a sternal rub to no end. My success rate is 100% as they instinctively reach for my arm to remove it.

    If a man I twist their nipples to about 720 degrees.. success is equally high. I do like some of the other suggestions in the room but I will keep with my current techniques.
  12. njac

    njac Senior Member

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    we have a couple frequent fliers who are quick to tell you about their special seizures - they're called "A-C-T" seizures - upon arrival. They're super rare or something.
  13. pinipig523

    pinipig523 I like my job!

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    Had a patient present yesterday - wife said that he's trying to wean himself off of heroin after 25 years of being on it. She says that he think he's withdrawing from it and having these jerking/myoclonic movements without affecting state of consciousness.

    Looked at the pupils - pinpoint b/l.

    Asked the wife, "So when was the last time he did heroin if he's trying to quit after 25 years?"

    "Right before we came into the ER."

    "Fantastic," I said.
  14. Jarabacoa

    Jarabacoa non carborundum ilegitemi

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    I think a tazer would be the best thing to use on a pseudoseizure. I had a cop tazer a patient a few months back. It was the coolest thing I've ever seen. The 6 foot 7 300 pound martial arts guru went from being aggressive, menacing, and psychotic to crying like a baby, exceedingly compliant and apologetic. Far more quick and effective than any zyprexa I've seen. I'm willing to bet the pseudo-seizure retards would never have another one the rest of their life.

    If only I were the King of the USA.
  15. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    "Recent evidence suggests that remote electroconvulsive therapy provides the most effective and durable treatment of 'seizures' Mr. Jones. Please hold still and face away from Officer Smith."
  16. Nervous Ned

    Nervous Ned

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    Sorry if this is a stupid question, but I had thought pseudoseizures were a conversion disorder. In other words, the patient isn't consciously faking them. This thread is making it sound more like it's malingering or factitious.
  17. Sweet Pea

    Sweet Pea

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    Most of the pseudoseizures I've seen I would call malingering or factitious rather than true conversion. . . . And my preference of treatment is sternal rub, works every time.
  18. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    If it was conversion, though, people wouldn't protect themselves. If they never knew what was actually a seizure, how could they fake one? Or, how about the shaking people that are saying to you, "I...ammmm.....haavvvinnnnggg....aaaaa.....SEIZURE!!!!!"? For them to fake it, they have had to either have had one before, or seen one (and, as an attending said years ago, "People that fake seizures have seizures, do have seizures").

    There was a woman that used to live in our fire district when I was a volunteer who would have factitious seizures. It was always at an inopportune moment. One time, it was actually when I was working EMS, and she had a "seizure" - when she couldn't pay the $0.50 bridge toll. I was surprised as hell when I saw this woman 20 miles from my volly district.

    Some may be unconscious, although not true seizures, but, at the same time, there always seems to be some secondary gain.
  19. The right Path

    The right Path Goodbye Cherry Ames

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    Just curious...

    Does suggesting a rectal dose of valium ever cure these "seizures"?
  20. TheBlueBlazer

    TheBlueBlazer

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    I just VERY thoroughly evaluate their rectal tone, temperature, and make sure to get a second opinion.

    While doing EMS, on a police standby, I saw a guy come running out of a surrounded house, and funny how the second he realized he was caught, and saw the K9s, his seizures started acting up. He did have a brief interval though where he was lucid enough to realize he was still surrounded and nobody was moving before starting up again.
  21. Daiphon

    Daiphon Semper Ubi Sub Ubi SDN Advisor

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    Absolutely love this... and it's EBM-based. d=)
  22. Socrates25

    Socrates25

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    The way you cure pseudoseizures is as follows:

    1. Tell the patient that it would be very helpful if they would have a seizure in the next 30 seconds while you are standing there so you can observe it.

    2. When the pt starts having the pseudoseizure, quickly thump them on the forehead unexpectedly and say "STOP"

    3. When the pt stops, tell them that it cant be real seizures because real seizures cant be stopped by such a stimulus. Tell the pt that this proves they are lying. Tell the pt to get the hell out of your ER.


    If that fails, tell them that they will have to get a spinal tap with no anesthesia every single time they have a pseudoseizure to "check for infection."
  23. pinipig523

    pinipig523 I like my job!

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    Awesome.. just awesome. :thumbup::thumbup::thumbup:
  24. zinjanthropus

    zinjanthropus

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    I'm also using Geodon a lot in general - our neuro dept uses it for pseudoseizures and I have done so as well in the ED. good drug.
  25. lockjaw

    lockjaw

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    You're right, there is a separate condition once known as "pseudoseizures," now termed "psychogenic non-epileptic seizures," which are not faked and are similar to conversion disorder. The name was changed in part to avoid confusion over whether someone using the term "pseudoseizure" was referring to factitious/malingering seizure-like activity vs. psychogenic, non-faked movements. I think most people in this thread are using the term to refer to factitious seizures.

  26. Venko

    Venko True to self Lifetime Donor

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    You're bringing up a great point.

    Last night I had a patient who was clearly not having an epileptic spell, but she was also not consciously making the movements she was making. I was explaining to my team that even if our most fit individual tried to continue to shake with the same rhythm as she did for that long straight it would not be possible.

    As a former psychiatry resident and now EM attending, I have a special piece of compassion for these individuals. I have found that if you are sure that it it is not a true seizure (as in yesterday, both legs, no arms, purposeful gaze, while face twitches), if you tell the patient you are providing a treatment (whatever it is gel on the forehead, sodium chloride in the IV etc) and give a reasonable expectation of when it will work (i.e. 1 minute), these generally stop.

    Now I look for what could have triggered the event. Sometimes I think of this like DKA, there could be any underlying infection, mechanical issue, etc that could trigger these events and patients with mental illnesses can sometimes not tell you whats going on.

    I hope this helps!

    As for those patients who are knowingly trying to get xanax, or opiates etc for seizures, some of the above maneuvers may be more appropriate...

    TL
  27. Redrox

    Redrox

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    Fakers can be annoying as hell, tying up our resources and sucking up time. But yeah I agree, actual conversion disorder, like any number of legit psych disorders, can be some sad situations.

    Had me a lady once who checked her blood sugar every day when stressed (wasn't a diabetic) and had full psuedoseizures every time it levels changed according some bizarre criteria. Educated lady, very kind and pollite, hated going to doctors, miserable, later extremely grateful for our special drug norMALsaline.

    Refused to see anybody from psych, willing to try a tablespoon of salt in glass of water at home but I'm still afraid we created a new frequent flyer. Wish we could have done more, but life's like that.

    More humorous/impressive of a conversion disorder was a young guy who basically did nonstop situp "seizures" his entire ED stay after hearing some bad GF relationship news.

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