How to differentiate between epilepsy and pseudo-seizures

I have seizure disorder (according to 3 neurologists) but getting the correct dx was a hard thing that took a lot of time and testing. It has never shown up on an EEG (and I have had 3 of 'em) and every MRI and PET etc has shown nothing. What I have always wondered is how can doctors diagnose one person with epilepsy and the next person with pseudo-seizures when both people have negative EEGs? What happens if they stop someones meds for epilepsy because they believe they are having pseudo-seizures and they are really have seizures that really just never show up on tests? How do they make they make the dx with no concrete proof?
If someone is faking seizures they come to almost immediately afterwards. They have muscle tone during the post ictal period too, often times we will lift their arm and see if it falls or if they can hold it up. If they can hold the arm up usually they are faking since a post ictal patient would let their arm just fall. They will stop when they are exposed to ammonia sniffer things.I had one pt who was pretending to seize, the phone rang, she talked to whoever had called, then hung up, and continued to seize. She had even let the docs intubate her before. We got her to stop by telling her we were going to do a painful procedure.

Pseudo-seizures aren't always people who are "pretending to seize". I actually wanted to have a dx of pseudo-seizures because it meant having my life back and my driver's license. All the neurologists said you couldn't tell someone having a true seizure from someone having a pseudo-seizure unless it was someone truly faking it. Their are a lot of people who have pseudo-seizures who truly believe they are having a seizure and don't have any control over it. I was just wondering how if every test came back normal, as can be the truth in either case, do they make the dx of seizure disorder.

Quote from LovebugLPNPseudo-seizures aren't always people who are "pretending to seize". I actually wanted to have a dx of pseudo-seizures because it meant having my life back and my driver's license. All the neurologists said you couldn't tell someone having a true seizure from someone having a pseudo-seizure unless it was someone truely faking it. Their are a lot of people who have pseudo-seizures who truely believe they are having a seizure and don't have any control over it. I was just wondering how if every test came back normal, as can be the truth in either case, do they make the dx of seizure disorder.

p.s. I got my license back by the way.steph

Lovebug,I was only sharing my experience with pseudo seizures. The ones I had seen they were truly faking seizures. You can get your license back as long as you are seizure free for a period of time, however I can't remember how long that is.

When I worked Pediatric ED, we had a "repeat customer" teen who liked to fake seizures at school. We all knew her. When she came to the ambulance bay, we'd break an ammonia capsule, and she'd immediately come to and be combative trying to move the capsule away. She did finally get the psych consult that she needed.

oh we had a pt who faked seziures , she would stand up and walk see one of us and lay down and start a fake seziure. one nurse got so fed up with her fake sezuires the next time she pulled this. he said to her " knock it off and get up off the floor" the doc was standing there and started laughing. the girl layed on the floor for a few minutes jerking , and when she saw the nurse and doc laughing at her , she got up and walked to bed. she jumped right up and it was so funny, i almost peed my pants. the docc said " your going home , goodbye" and she left very fast escorted by security. before she left she said " one more shot of ativan please, the nurse said " goodbye"... we knew she was faking and just there for the drugs, and finally someone just got fed up with her nonsense.

Quote from nrsang97Lovebug,I was only sharing my experience with pseudo seizures. The ones I had seen they were truly faking seizures. You can get your license back as long as you are seizure free for a period of time, however I can't remember how long that is.

M step-mother was diagnosis with pseudo-seizures and one way they mentioned was that she didn't lose bowel/bladder control. Also, the post-tical period was non-existent.

many years ago i worked a neuro science/surgical unit. we had 4 rooms all with cameras that were for our seizure pts. they were on 24/hr eeg monitoring. they also had a button they would hit if they had an aura, or the monitor would go off if it sensed a spike in the eeg. if we were in the room and noticed a seizure we would then "task" them for the cameras. this would enable the neurologist to pinpoint exactly where the seizure was coming from in the brain,thus ruling IN epilepsy. it also was a way to rule out epilepsy. trust me i have seen some pretty fake looking "real" seizures and some pretty real looking "fake" seizures. I have taken care of people dx for years with pseudo seizures and then after 24 monitoring were dx with partial complex epilepsy. however,75% or our pts were diagnosed with pseudo aka non epileptic seizures. those people were then referred to neuro psych. most of them were put back on neuroleptics. I really hate the term pseudo seizure. it implies that the person is consciously faking it. i prefer the term non epileptic. many of the people diagnosed with this do not realize that they are doing it. with that being said, there are those that are doing it for other reasons. such as serious psych issues.with that being said, there are ways to tell a true generalized tonic clonic vs "faked"1)they always drop their sats and usually turn an icky shade of grey/blue/purple2) there is usually some sort of post ictal state3) they may become incontinent, or have tonic related injuries, i.e. tongue bleeding or muscle soreness after.4) their lab chemistries, and even abg are totally out of whackthe only way, inmho to truly diagnose epilepsy vs non epilepsy is the 24 hour monitoring. doctors cannot predict when and if one is going to have a seizure, even if it is sleep deprived, unless while getting the eeg, they say or do something to imply that they are having one. at this point they will be able to see disturbances on the eeg. hope this helps

I remember one guy with pseudo seizures. He was seizing and the Doctor was talking to his family and his nurses the differences in seizures. And how true seizure patients were truly incontinent of urine. Right then the patient went and urinated on himself. Did the doctor offer to help the nurses clean him up. NO. As his family is shouting look it is a real seizure.

I just want to relay my experience... I have epilepsy and work in the medical field.But during one of the many trips to the ER trying to get help for this in the wee hours of the night while I was so new to it were complicated and frustrating to me.The frustration came from the lack of belief. It was assumed that I had pseudo epilepsy obviously. I was so upset and crying especially after one of the physcians, who happened to also be the Director, had left me along side the nurses station on a stretcher while he yelled at me in front of others. He yelled that I was using up space others needed. Further, he insisted that I did not have a seizure, nor epilepsy.So I left AMA crying my heart out, I was so embarrassed.Well, the following day I happened to have an EEG that had been ordered from my own primary physician scheduled at that very same hospital. I was so hesitant but took it anyway. And I am glad I did.THe EEG showed an abnormal study: Findings are consistent with epileptiform discharge arising from the left frontotemporal region. I was having a series of recurrent seizures obviously.I was so tempted to flash my report right in front of that Director/physician at that ER especially! I didn't though.