The first time you witness a seizure most people, ordinary people and paramedics alike, all tend to think the person is going to die -- in some cases, were you not to intervene chemically with the progression of their seizure, some may die; however, as a general rule, most people who have seizures will eventually find that they self resolve. In fact in many cases, people don’t even realise that they’ve been having seizures for years until someone witnesses the event.
Okay, so what does this all have to do with pseudo fitters (pseudo-seizures)? Well, the first time you see a person have a real seizure, you think they’re going to die and when you see a pseudo fitter for the first time, you are likely to think the same thing. Some pseudo fitters will have previously had epilepsy, or had a friend with epilepsy, and consequently, can act out a seizure very well. In many cases, they will go as far as to let themselves become incontinent (wet themselves).
This is a link to a great video clip of a pseudo-fitter which I think about every time I treat a pseudo-fitter!
The truth is, most seizures self resolve, and so long as a person is still able to manage their own airway, and keep breathing, they will be fine. Therefore, if you are concerned about whether or not a person is having a real seizure or a pseudo seizure, then these are some things to keep in mind:
1. Check persons ABC (is their airway clear, are they breathing, how is their pulse?).
2. Check their full vital signs (this should include a BSL and a Temperature). In a person having a real seizure, their pulse is almost always up around 120/min or greater, as a means to increase brain perfusion and remove lactic acid being created through the tonic/clonic movements of their limbs. A regular pulse at around 80/min is almost always a give away that a person is faking their seizure.
3. Assess their corneal reflexes (do their eyes blink when you touch their eye lashes?) -- Corneal reflexes ussually only occur in conscious people, not unconscious people having a seizure (although there are some rare occasions where this is not true). Assess their pupils.
4. If in doubt about whether or not the person is faking their seizure, manage their ABCs and transport to hospital -- provide them oxygen and posture them latterally. Ultimately, if you become concerned about their airway and think that they really are causing damage -- there is nothing wrong with giving midazolam (it doesn’t cost you anything).