Sometimes You Just Gotta Move

I have officially been a doctor about... oh... one and twelve thirteenths years now. Around the one and seven thirteenth mark I came to a realization about my job that although not particularly revolutionary is still remarkable. That is: there is no escaping the crazy and the boring. No matter what path I decide to take in medicine I will always have patients that are loony toony or just dull, tedious, and boring. For a while I had had reservations about pursuing a career in infectious disease due to the tendency for infectious disease docs to be the antibiotic monkeys of the orthopedic surgeons -- resulting often in clinic visits with nothing more than a demented patient, a handful of illegible nursing notes, and a PICC line -- but now I know we all got our burdens to bear.

This realization came during my neurology rotation. Although I already knew neurology to be full of the dull, tedious, and boring I was caught off guard by the amount of crazy. Where as rheumatologists have fibromyalgia, endocrinologists have "hypoglycemia", cardiologists have "chest pain", and allergists have their entire careers, neurologists have pseudoseizures. Pseudoseizures, for those not in the know, are seizures that aren't really there. Hence the prefix pseudo-. The more politically correct term currently is "psychogenic non-epileptic seizure" but I imagine this will be the case only as long as it takes people to realize "psychogenic" means "full of crap." In every case people twist and turn, writhe and shake, hop and bounce all convinced they're having a seizure when, in reality, they've just got a case of ants in the pants.

The reason pseudoseizures are such a pain is both because of the high incidence of personality disorders associated with them and the requirement of a 72 hour sleep deprivation study to diagnose them. Regular seizures are hard to provoke but it turns out not letting someone sleep for a long time is a pretty good way to do it. It is also unfortunately a pretty good way to make a healthy but ornery person into a healthy but fairly irrational and agitated person as well. The purpose of the study is to capture on video and electroencephalogram (EEG) a purported seizure. Comparing their movements and brain waves gives a nearly infallible assessment of whether the seizure is genuine or not. Although some people can fake seizures with the best of 'em, it turns out it is hard to fake an EEG.

Thankfully, amongst all the painful explaining that all the Depakote in the world won't stop you from having the seizures you aren't having, there are the lighter moments. Specifically, when the patients are *not* good at faking seizures. During my month on the neurology service there was all kinds of wackiness but the best "seizures" of the month were memorable. Runner up went to lady who back flipped off the hospital bed while first prize went to young dude who did some sort of fully upright hokey pokey. In the words of a colleague, "that's not a seizure. That's a dance move." I am sure people with pseudoseizures have great struggles both with their condition and in life, but, man, if you're was going to fake a disease at least take some disease faking classes first. Or go with psychotic parasitosis. Prove to me I don't have parasites!