You are called to a 21-year-old female currently having a seizure. You don’t know much information, but you know the seizure has lasted longer than 5 minutes. You arrive shortly after the call was taken to a large council office and are directed inside by a member of staff. She tells you the patient has regular seizures, and this one seems to be like past ones. The patient is currently with a new social worker, and it is she who has called for the ambulance. As you arrive, you see the patient on the floor and their arms are aggressively moving up and down, the rest of the body is fairly still. The staff member who has escorted you states she is going to the office to get the patients emergency care plan and will be back in 5 minutes.
The patient is still seizing but something doesn’t feel right. The patient seems to be tracking your presence as you approach.
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The patient is still seizing so you need to control it, what do you do next?
You learn from the patient’s social worker that the patient has regular seizures and they are related to her stress levels. She has had a traumatic childhood and several mental health diagnoses in the past which seem to have stemmed from this. Her seizures can last a long time and she recovers very quickly from them, however, she will normally feel very tired afterwards. The social worker doesn’t know much more history but has been with her all day and has stated that apart from stress related to recent exams, she has been very fit and well all day.
The observations you record are: 96 HR, 26 RR, 99% Sp02, 36.8 Temp and 6.3 Blood sugar. You are unable to get a blood pressure due to the arm movement.
What would be your primary diagnosis for this patient with the information collected so far?
The other staff member comes back with the emergency management plan for this patient which confirms her diagnosis of psychogenic non-epileptic seizures. What treatment would be required for these seizures? TICK ALL THAT APPLY
You find after a bit of reassurance and talking to the patient, the seizure starts to slow. After a few seconds of the patient gathering her thoughts, you can converse with her and she starts to apologise profusely. You try to build rapport with the patient and glean further information about her history. What term is generally more accepted to call these types of seizures according to recent focus groups and research?
Patients always have a choice whether they have a functional seizure?
The patient confirms she is not injured and has no new symptoms, she states this has been a normal seizure experience, but has been getting them more frequently recently because of increased stress. Due to increased frequency of her seizures, you must recommend further assessment in hospital?
What treatment may benefit patients who suffer from functional seizures and may influence what treatment plan and referrals you make for this patient?
If you have clinical doubt whether the patient is having an epileptic seizure or functional seizure, you should treat as an epileptic seizure and start drug treatment with benzodiazepines?
What symptoms would you expect to see with functional seizures that may differ to epileptic seizures?
Following a good discussion with the patient, they are happy to remain on scene with the necessary safety netting put in place. You also discussed several treatments and practices that can help with her seizures, and she says she will explore these avenues to help with further care. What risk factors have been shown to be associated with Functional seizures?
What percentage of seizures that present within an emergency department are classed as functional seizures?
What assessment is required to definitively diagnose functional seizures and distinguished from epileptic seizures?
Approximately how long does it take a patient to gain a diagnosis of functional seizures after a first seizure?
Prolonged functional seizures are still regularly associated with an increased risk of physiological derangement and/or brain injury?
Is a diagnosis of functional seizures a reportable medical condition to the DVLA and potentially effect their qualification to drive?
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