I have a question for you all?
Epilepsy…..How good are you at telling the real seizures from the pseudo?
I had a job the other week where I was called to a female? fitting in the street.
When I got there, she appeared lucid, alert and orientated. There had been no incontinence, she did not appear post ictal (confused) in any way and was able to walk unaided to the rapid response car for further assessment.
Whilst sitting in the back of the car, she suddenly shouted out
“I’m going to have another one”
Whereby she started to ‘fit’ for about 1 minute before suddenly coming round with a start and asking in a confused manner
“Where am I, What happened?”
In this case, I was sure that she was ‘faking it’, for use for use of a better word. However, she did a really got job of making it look like a true tonic clonic seizure, apart from keeping her eyes tightly closed throughout and her movements were just a little to co-ordinated.
It transpired that she had a daughter who is actually epileptic so she has had ample opportunity to see what a real fit looks like.
I also understand that there are a multitude of different variations of epilepsy ranging from absences to partial seizures to grand mals and a myriad of others in between.
I think I am good at spotting the real from the not so real, but I sometimes wonder if I have ever assumed that the patient was faking it when in reality, they had some odd type of epilepsy which manifests itself in a strange way, and with no confusion following it.
I think it’s time to read up a bit, or try to get to speak to a neurologist about it. Any of my readers a neurologist??……No? Oh well, worth a try.
I guess I will just have to continue on the way that I do. Treat the patient as they present. If I think that they are not really having a fit, then I will still care for them and monitor them closely. My patient report form will continue to be professional and will not state that the patient is faking, but instead will state the facts:
“Patient appears alert and orientated throughout the fit”
“Patient appeared to have a ? fit, but observations remained within normal limits throughout”
“Patient had a ? grand mal seizure in my presence, which stopped abruptly with loud sudden verbal stimuli”
Etc etc etc.
It all reminds me of the first experience of a pseudo fitter I had with a paramedic colleague, Rob, when I first started in the service. Picture the scene….
We arrive and move from the ambulance and walk into the centre of a large park where a group of about 10 youths, aged from 14-17 are standing around one of their mates who is currently thrashing around on the floor as if being electrocuted from all different sides. Even as a brand new advanced tech, it was easy to see that he was giving it his all in his portrayal of someone having a grand mal seizure.
Friend 1: “Help him quick! You gotta help him!! He’s dying.
Rob walks over and takes one look at him then turns back to his friend and puts his hands in his trouser pockets and shrugs.
Friend 1: “What are you doing?? Help him!! He’s gonna die unless you do something.
Rob: ” No he`s not”
Friend 1: “Yes he is!! He’s fitting!”
Rob: ” No he’s not”
Friend 1: “Well what’s he F*@king doing then??”
Rob: “He’s just being a very naughty boy”
Classic! Absolutely Classic.
I still smile when I remember that job. Rob had such a deadpan sense of humour, he just delivered the line so well. The ‘patient’ very shortly afterwards suddenly came round, dusted himself off and walked off with his friends.
That one was a definite, but are all the ‘fakers’ really faking?
That is my question to you. How can we really be sure in each and every case?