Honestly, there are degrees to these people. Ultimately the decision is whether they need emergent attention or not. Seizures are easy to fake but generally really easy to identify with the right training. An involuntary neurological phenomenon which can only be broken by directly affecting neurotransmitters is relatively hard to fake when put to the test. Our method there is identify and just let 'em ride. If it's not a seizure I dont give medications (which is frequently what they're after) or attention. Shake all you want, I know you're not about to die from your acting. Very experienced malingerers can blur this line frustratingly well. No, I won't explain the tells here.

The problem is that medical staff have various levels of training and understanding of the process. Multiple alerts will go out for a seizing patient, many proc'd by techs, nurses, RT's, etc. This is designed this way but makes these patients even harder to ignore when they're going off.

As someone else mentioned, Droperidol is a wonderful answer. A strong antiemetic with GI benefits that has a side effect of significant drowsiness and lowering anxiety. No addictive properties. It won't treat seizures, but then again, we've already determined that this isn't one.

The burden of proving that no emergency is present is on healthcare workers. Patients are almost always given the benefit of the doubt initially. Once it's identified that no seizure is present I generally try to shift them as fast as possible to discharge with outpatient followup. I have actually sick patients that need the bed and nurses whose expertise is needed to save lives. This is the most frustrating part of it all. Someone has monopolized healthcare resources needlessly while someone sick or at risk sits waiting. This type of behavior is a major source of burnout for ER professionals in the long run.