[firemedic]

I am a fireman / paramedic and need some help with a regular patient. We have been called to his house 2 to 3 times a month for the last year. He is 12 years old and has what the family describes as tonic / clonic seizures. We have never witnessed one of these seizures and niether has the hospital staff. Our patient is never postictal, and we are on scene within 3 minutes of the call. 90% of the time the seizures occur between 10pm and 11pm. Is it possible to have this type of seizure without a postictal phase or are we dealing with more of a psychological / behavioral problem? The patients family have changed hospital destinations, due to the fact that the hospital said they don't believe he is having seizures Hospital #2 has tried a couple of seizure meds, neither have worked. We always treat our patient as though he has had a seizure and never dismiss it as nothing. I would just like to know a little more about what we might be dealing with.
Thanks,
Concerned Fireman

[jdmedic]

I am a paramedic and have had several patients with what I have been told are "pseudo" seizures. I have witnessed what could be described as seizure related behavior - blank stares and clenched muscles - but no tonic/clonic activity or loss of bladder/bowel function. The patients I have had with pseudo seizures have not had what I would label a true postictal state. All 3 of the patients I can readily remember were still being evaluated and were on different meds. Depending who you talk to these people have a psychosomatic issue or the cause has just not been identified. I did the "hand drop" test with one of the patients and she failed it. At the ED the doc stuck amonia capsules into an O2 mask and the patient "woke up" immediately. So, you decide.

On the other hand, I went to a doc's office for an elderly woman "having a seizure" and when I got there she was sitting in a chair fully awake with no postictal like symptoms. I was told she had 2 seizures while in the doc's office. Fortunately as soon as I put the patient in the ambulance I hooked up a 12 lead ECG because she seemed to be going into another "seizure". What occured was bradycardia that went into a 2nd degree AV block accompanied by hypotension. When the bradycardia was initially treated with Atropine, she improved slightly and then went into the block followed by 3rd degree block with syncope. I paced her and by the time we got to the hospital she was back to baseline. I found out on my next shift that she was admitted to have a pacer implanted but that night she had several periods of asystole so they put in a temporary pacer that night. What her family and her family doc had labeled seizures were probably syncopal episodes because of the underlying heart disease.

Hope this helps.

Maybe you have an answer for me. I had a seizure patient with a complex partial seizure that before my eyes appeared to deteriorate into a stroke (facial droop, slurred speech, decreased LOC, L sided weakness). We immediately transported to a nearby Stroke Center. I returned there with another patient later that day and checked on the status of the first patient. As they were getting ready to take her to CT scan she suddenly returned to normal. All the symptoms cleared without any intervention other than O2. The doc told me the name of the disease or syndrome that causes stroke like symptoms during the postictal phase and although I recalled reading about it, I have forgotten the name. Any idea?

[countrygirl1212]

My daughter is also has epilepsy, myoclonic seizures is the diagnoses. She has never in her life had any other problems other then epilepsy and being developmently delay. Recently she has started having what all the school nurses and the medics thought to be seizures, they look like a regular clonic seizure. My daughter is 14 and these started in October. She has had a MRI and EEG, all coming back normal no seizure activity at all. With 3 different hospital and many many different test, they have determined that this is not at all seizure activity. She has head Jerks and her eyes blink, However she can reply when spoken to. she is awake and aware of her surroundings, she is also able to stop them when she has relaxed or wants something. The doctors have told me this is a behavioral problem, basically she is doing it because she can not say how exactly she is feeling so she goes into her other world I guess I should say. There are times that it may be a half hour and she can't control it other times she can stop it in 5 minutes. This child is not faking it she can't control what is happening all the time, you can see that she is upset that this going on. Seizure meds do not work if it is psycological. We have found that because of the epilepsy and they developmental problems that she does not always know how to express her angeror frustration so these episodes happen. Hope this helps if you have any question feel free to. I am interested to see if anyone else responses to your message.