If you’ve worked in the emergency department for a few years, you will have seen a pseudo-seizure and hopefully have picked it. I know I was terrified of these in the early days, as I had trouble making the diagnosis and I had seen neurologists get it wrong. Now, they are a little easier to pick.
I’m not one to do prolactin levels and blood gases in this group, although I do look at pulse oximetry, which should show a decreased oxygen saturation, during a real seizure.
Here are some other tips that might help you. Be careful as there are always exceptions and always err on the side of giving your patient the benefit of the doubt.