Several years ago, I witnessed a patient with pseudoseizures. She was investigated for all number of neurologic disorders, and some of her seizures were real; stress induced. It appears retrospectively that the others were mostly an attention grab. It scared many of the people who knew her.
More recently, a nurse friend of mine related to me a few stories about patients with pseudoseizures, in what would best be described as a light-hearted tone. The lengths some patients would go to defend their 'seizures' were just plain silly.
Picture a patient accused of faking a tonic-clonic seizure stopping and saying "I
am so having a seizure!" Or when one nurse remarks to the other, within the patient's earshot, "You shouldn't leave those fluoro lights on, they can set off seizures." Needless to say, a 'seizure' ensued within seconds.
Let me be clear; Pseudoseizures are not funny. Evidently, there are some potentially humorous stories
about pseudoseizures, but, in person, to witness or to have, they are not funny. More appropriate adjectives might include worrisome, concerning, irritating and dangerous.
You see, the population most at risk of pseudoseizures is, in fact, patients whom suffer (genuine) seizures. Chances are, if you present with refractory, extremely convincing, pseudoseizures, you'll be treated via the same protocols as for status epilepticus. Not fun.
There's a long list of things that cause seizures. It's a pretty serious list, too, being that seizures are oftentimes life threatening. Uncontrolled epilepsy, brain tumours, drug overdoses and the like are, well, they're a formidable lot; the cause of any seizure certainly warrants a full investigation.
Thankfully, most textbooks point out the common features of pseudoseizures that are not consistent with seizures. These include pelvic thrusting, a lack of head thrashing, ability to listen to and abide by instructions, eyes tracking across the room and a lack of post-ictal confusion. It's also worthwhile noting that urinary incontinence has been known to occur in what would be best described as
severe pseudoseizures.
And, deep down, you might understand some of the logic; these patients have a history of seizures and crikey, they know what kind of response it gets. Plus, it's far less risky than attempting to top yourself, and much more socially acceptable than throwing a temper-tantrum. So, why not fake the odd one, just now and then. Going out on a limb, I'd say that there's certainly another common denominator with seizures and pseudoseizures; Stress.
Psychological stress does messed up things to people most of the time, but, hang, throw a neurological disorder into the mix and it's all on.
By this stage of the post, the chances are that readers who are familiar with seizures are a wee bit miffed. I'm sorry. I'm not blanket accusing seizure sufferers of attention-seeking. Not in the slightest. As I've mentioned earlier, seizures are a big deal and should be appropriately treated and, after the event should
not be negatively socially stigmatised.
What I am trying to illustrate is that seizures, pseudo- or otherwise are freaking scary entities, not least for the person they're happening to. But a pseudoseizure, if a patient's having one consciously and intentionally, is like a really nasty joke to which only they'll ever get the punchline. Kind of like the opposite to a
Dissociative Fugue...
