Medical Question – Seizure Workup

From Kim Kessler, “I have a scenario in my book where an anxiety attack leads to a pseudo-seizure, which the internet says is a real thing. So what sort of EMT / hospital stuff would happen after that?”

Great idea! Anxiety/panic can definitely lead to a pseudo-seizure, but of course we can’t immediately know that’s what it is. We would first have to rule-out other causes, particularly those that are life-threatening. For an adult who has collapsed from an apparent seizure, here are things that would be asked immediately:

  • First, a description. Seizures last seconds to minutes, so EMS (emergency medical services) would likely not arrive during the seizure. Though you could have it recur while they are present to avoid confusion over whether it was just a fainting spell or a seizure.
  • Does she have a seizure disorder? has this ever happened before?
  • Any recent head trauma?
  • Drugs/alcohol?
  • Current illness? esp with a fever?
  • Anything that came before the seizure? acting strangely, changes in speech, worsening headaches, etc.
  • Anything precipitating event, occurring immediately before? strobe lights, strong emotions, loud music, intense exercise.
    • Interesting Tidbit: In 1997, >500 kids watching a Pokemon cartoon had a seizure. For the majority they’d never had one before. – Might be fun to incorporate in a story someday.
  • If the person is pregnant, a new seizure would be blamed on “eclampsia” until proven otherwise. This is a complication of preeclampsia (FKA toxemia), a disease of high blood pressure in pregnancy.

In addition to history, things we would do:

  • Check labs for glucose (diabetic seizure) and other chemicals as well as a drug screen
  • A CT scan (computed tomography, not the meow kind, though often pronounced like the latter) – much quicker and less expensive than an MRI, but less informative. It can tell whether there is a brain tumor, or a bleed from head trauma or a ruptured aneurysm.
  • An EEG (electroencephalogram) – tiny electrodes placed all over the scalp and monitored for seizure activity. This is usually 20-30 min, and often shows nothing if the patient isn’t actively seizing.
    • For probable pseudoseizure we might do Video-EEG monitoring, where the patient is video-taped for hours with simultaneous EEG. When she has physical seizure activity without changes in the brain electrical activity, we know it’s a pseudoseizure.
      • Interestingly, sometimes the neurologist will try “spell induction,” like a placebo to cause a seizure. They give the patient something innocuous (like saline) but tell them it will likely cause a seizure…and 75% of the time it does!  Much less often if it’s a real seizure.
  • Possibly an LP (lumbar puncture or spinal tap) – take fluid from the spine, which also bathes the brain, and look for evidence of infection. Generally would only be done if the patient has other symptoms of infection (fever, high “white count” – the blood cells that fight infection).

Incidentally, if a patient is found to have a real seizure and has to go on medications, they won’t be allowed to drive for a period of time. Generally they have to be seizure-free for several months before regaining their license.

  • More story-fodder – someone who drives against medical advice, has a seizure and causes a fatal accident. Maybe tries to hide their identity to avoid blame and things spiral from there?

Let me know if there are further questions on seizures and their evaluation!!

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