Treatment causing Seizures

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Ok folks. I could do with some pretty smart advice. ASAP

On Saturday i saw a new client. 84 yrs male. H/O Heart Disease quadruple bypass. Nothing else significant disclosed

The patient underwent a full assessment including RS tuning fork and 10g monofilament and basic doppler.

He then had a treatment and sand.

On applying the emollient he didnt answer me so i looked up and he was putting his hand to his eye and seemed disorientated. I asked him if he was ok and he said yes. He clearly wasnt. At this point i thought he was having a TIA. I immediately picked up the phone and dialled 000. He then started to undergo a seizure salivating, shaking and urination.

He was took to the hospital to be later discharged and told that maybe the Podiatrist touched a nerve on his foot which triggered the seizure. He had blood tests but no CT/MRI scans.

Today he told me he has previously had one or two dizzy spells which were put down to his ears. He believes the doctors to be right. 1. The dizzy spells are a result of his ears and 2. The podiatrist caused the seizures.

The patient drove himself to the clinic on the day and is still driving today.

I feel compelled to write to the GP stating how unlikely this senario would be but would like to know if anyone knows of any evidence which supports "Podiatrists causing seizures during treatments! before i put my plan in action.

I am a sole practioner and would really appreciate peoples thoughts on this matter

thanks

 

The chances that your patient had a seizure as a result of you touching a nerve in his foot is about as likely as me flying to Mars tomorrow! If you inflicted some significant pain to your patient immediately prior to the seizure then its possible that he had a syncopal (faint) response to the pain as people who faint, particularly if they are in a sitting position can often appear to have a seizure, although this is usually more just 'twitching' movements and doesn't usually involve salivating at the mouth or generalised tonic/clonic movements. If it is a faint any 'seizure' activity and return of consciousness will usually occur very rapidly (usually within seconds) once the patient is positioned supine (or lateral position). Syncopal episodes (and subsequent seizure like activity) can also be caused by sudden onset cardiac arrhythmias, hypovolaemia etc.

If it was a true seizure, and part of your description points to this, and it was his first time seizure then he should have undergone a CT scan at hospital. The differential Dx for a first time seizure is long including CVA; Intracerebral mass (tumour, bleed, abscess, aneurysm etc) and should have been excluded with a CT scan.

A true seizure almost always has a post ictal period where the patient is initially unconscious after the seizure activity has stopped and then slowly regains consciousness over the next five to ten minutes (depending on the length of the seizure) with some confusion lasting up to 30mins or more.

The other thing to remember is that a seizure nearly always occurs in a patient who has a sudden cardiac arrest so its important to check for effective breathing and pulse as soon as the seizure activity has ceased.

In summary: 1) You have more chance of winning divison one in the lotto for the next ten consecutive weeks than your patients seizure being caused by you touching a nerve in his foot (unless you had caused him signifcant pain immediately prior).
2) If it was truly his first time seizure he should have had a CT scan.
3) You probably should write a letter to his GP describing what happened, it's then up to him/her to pursue it further.
4) If he had a seizure he shouldn't be driving!

The diagnosis of podaitrist induced seizure is a lazy diagnosis by the hospital!!!

 

Agreed 100%. My vote is something is going on upstairs!! My reckoning is that there maybe major stroke on its way.
ECG trace was perfect.

BG's 7.9mmol 4 hours post prandial

I knew they should have done a CT and asked him today, he said they only did bloods. He still believes his dizzy spells are a result of his ears!!!

Just wanted to check there was no obscure research somewhere stating vibration can trigger seizures in those susceptible.


ta

I better book my flight to mars and put on my lottery ticket

Incidentally the patient waiting heard and saw the urination on the floor and stated "im not going to sit in that chair am i?" dont ya just luv em

 

I agree with the general mood. A podiatrist ouching/stimulating a nerve in the foot causing sucha reaction is absolute tosh of the highest order. The most likely scenario is likely to be what wasi called a petit mal years ago. The probability is that a combination of fluctuating blood sugar/sodium levels and stress/anxiety/relief.
Seen it before in my own clinc on occassions, there may be no previous history or the patient may lie to you about that, the do often.
Note it and if you need to report it in the accident/incident file and carry on you did nowt wrong.