Disclaimers: If you think someone is having a seizure, convulsive activity that is almost always hallmarked by a lack of consciousness, get medical help. If it turns out that it’s not a seizure, it may be something they can’t control and need help with anyway. And even if it is all for some psychogenic secondary gain, they still definitely need help.
How To Identify a Seizure
There are some big clues that should lead you to believe that someone experiencing convulsive activity isn’t having a real seizure. As stared above, this type of activity is called a pseudo seizure.
A real seizure is going to be associated with two very important things. One, something called a post ictal state. The term ictal means seizure. So, a post ictal state is classically a state of lethargy that a patient that has just had a seizure will experience. They will ask sleepy, slightly confused, really tired, and out of it, as consciousness returns. Tired is the most Important feature of the post ictal state. So, if it was just a pseudo seizure that they experienced, they demonstrate no fatigue afterwards at all.
The second thing that happens in association with a real seizure is laboratory abnormalities. So, blood is drawn after the seizure’s done. And if it’s completely normal, that patient probably did not have a seizure. One of the classic things that goes up with almost any kind of seizure activity is your lactic acid levels (Just the prospect of getting blood drawn to rule and seizure activity is enough to get many malingering patients to disclose the truth). So, lactic acidosis is a good guide in helping the clinician determine whether or not they are dealing with seizure activity; or pseudo seizure activity.
(Note the clever segue…)
So, you’ve determined that someone is having a pseudo seizure.
Characteristics of Pseudo Seizures
Pseudo seizures range in degree on two very distinguishing characteristics. One, they range along a functional spectrum that the body is actually having; and they range in the degree of psychogenic problem that the patient is having. They may even have a component of each.
Clinicians treating pseudo seizure disorders refer to the following:
F-ness: physiologic (Function is off)
The degree to which bodily function is off in a pseudo seizure it’s called its degree of F-ness.
The degree to which the patient has some sort of psychogenic disturbance is called the pseudoseizures degree of P-ness.
Kind of a built-in pneumonic for F-ness. After all, PHysiologic has an “F“ sound. And physiology is all about Function.
P-ness. Well… No, I’m not trying to be rude. It is simply the degree of Psychogenic (P, Psychogenic) quality involved with the pseudo seizure under review.