Distinguishing between a genuine medical seizure and one that may be feigned can be challenging. A seizure generally involves a sudden, uncontrolled electrical disturbance in the brain, leading to changes in behavior, movements, feelings, or consciousness. Some individuals might exhibit seizure-like behaviors that are not due to neurological causes. Understanding these distinctions is important for appropriate and safe responses.
Characteristics of Genuine Seizures
Genuine seizures, also known as epileptic seizures, arise from abnormal electrical activity within the brain. These involuntary events mean the person has no conscious control over their actions. Common signs include temporary loss of consciousness or awareness, and uncontrolled muscle movements, such as rhythmic jerking or body stiffening.
Following a genuine seizure, individuals typically experience a postictal state, a period of confusion, drowsiness, and disorientation. This recovery phase can last from minutes to hours, and during this time, the person may not remember the event. The eyes might be open with a blank stare or rolled back.
Key Indicators of Feigned Seizures
Feigned seizures, also known as Psychogenic Non-Epileptic Seizures (PNES), resemble epileptic seizures but do not stem from abnormal brain electrical activity. While some PNES are involuntary responses to psychological stress, others might be consciously feigned.
Indicators include a lack of typical seizure progression; genuine seizures often follow a patterned onset, whereas feigned events may begin abruptly without prodromal symptoms. Movements during a feigned seizure might appear purposeful, such as flailing limbs that avoid injury or a controlled fall. The person might resist examination, like attempts to open their eyelids, or purposefully look around. In contrast, eyes in a genuine seizure are often fixed, rolled back, or tightly closed.
Movements can be inconsistent or exaggerated, not following known seizure patterns, such as excessive back arching or thrashing without rhythm. There might be apparent awareness of surroundings or an ability to respond to commands during the “seizure,” which is rare during a genuine epileptic event involving impaired consciousness. Organized vocalizations like talking or crying during the episode can also suggest a feigned event.
A significant indicator is the absence of a postictal state; individuals feigning a seizure often return rapidly to normal behavior and cognition without the confusion, drowsiness, or memory loss typical of a genuine seizure. A “seizure” occurring only in the presence of others, especially when attention is desired, may raise suspicion. Feigned seizures can also be significantly longer than typical epileptic seizures.
Responding to a Suspected Feigned Seizure
When observing someone exhibiting seizure-like activity, prioritize safety and initially treat the event as genuine. Ensure the person is not at risk of injury by gently guiding them to the ground and removing any nearby hazards. Do not attempt to restrain the individual or place anything in their mouth.
While ensuring safety, observe the individual discreetly. Note specific behaviors, the duration of the event, and its context without directly challenging the person. Maintaining a calm demeanor can help manage the situation.
Avoid engaging in conversation or responding to the “seizure” in a way that provides attention, as this might reinforce the behavior if feigned. Remember that such behaviors can be an involuntary response to underlying psychological issues, even if not consciously faked.
If concerns persist or incidents recur, seek professional advice from a medical or mental health expert. A definitive diagnosis often requires specialized evaluation, such as video electroencephalography (EEG), which differentiates between epileptic and non-epileptic events by recording brain activity during the episode.