Evidence of a functional disorder as the cause of many ...
“Cryptogenic Drop Attacks” revisited – evidence of overlap with Functional Neurological DisorderIngrid Hoeritzauer 1 MRCP, Alan Carson1, 2,3 MD FRCPsych FRCP, Jon Stone 1,3 MDPhD FRCP1Centre for Clinical Brain Sciences, University of Edinburgh, UK2 Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK 3Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UKCorresponding author:Jon StoneConsultant Neurologist and Honorary ReaderDepartment of Clinical NeurosciencesWestern General Hospital, Edinburgh, EH4 2XU, UKT: +44 (0)131 5371167F: +44 (0) 131 537 1132E: Jon.Stone@ed.ac.ukEmail Address for other authors: Ingrid.hoeritzauer@ed.ac.uk, Alan.Carson@nhslothian.scot.nhs.ukRunning Title: Cryptogenic drop attacksAbstract word Count: 250Word Count (excluding abstract, tables, references): 3682Tables: Three (two additional supplementary tables) Figures: OneReferences: 40Key Words: 1. Drop attacks 2. Cryptogenic 3. Psychogenic 4. Non-epileptic 5. Functional Neurological Symptom DisorderKey clinical Points included in supplementary dataABSTRACT OBJECTIVEIn their 1973 BMJ paper ‘ Cryptogenic Drop Attacks’, Stevens and Matthews described 40, mostly middle aged, female patients with drop attacks of unknown cause. Although clinically common, there has been little on this topic since. We aimed to determine clinical features, comorbidity and outcome of patients with drop attacks.METHODSWe carried out a retrospective review of patients with cryptogenic drop attacks seen consecutively by one clinician (JS) between 2006 and 2016. Demographics, phenomenology, duration and frequency of attacks, attack description and comorbid diagnoses were recorded. Patients were followed up with a notes review.RESULTS83 patients with cryptogenic drop attacks were predominantly female (89%,n=79) mean age 44yrs. The majority (93%,n=77) could not remember the fall itself and almost half (43%, n=36) experienced prodromal dissociative symptoms. Mechanical trips or syncope preceded drop attacks, historically, in 24% (n=20) of cases. Persistent fatigue (73%,n=61), chronic pain (40%,n=33), functional limb weakness (31%,n=26) and dissociative (non-epileptic) attacks 28% (n=23) were common, with the latter usually preceding or emerging from drop attacks. At follow-up (88%,mean 38 months), 28% (n=23) had resolution of their drop attacks. Predisposing (but non-causative) disease comorbidity was found at baseline (n=12) and follow up (n=5).CONCLUSIONSCryptogenic drop attacks are associated with high frequency of comorbid functional somatic and functional neurological disorders. Patients commonly have prodromal dissociative symptoms and in some there was a clear relationship with prior or subsequent dissociative (non-epileptic) attacks. Some cryptogenic drop attacks may be best understood as phenomena on the spectrum of dissociative attacks.INTRODUCTIONCryptogenic drop attacks were defined in a seminal paper by Stevens and Matthews in 1973 as falls without warning, without clear cause of loss of consciousness, ‘vertigo or other cephalic sensation’ and with rapid recovery, occurring predominantly in middle- aged womenADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.1.5851.439", "ISSN" : "0959-8138", "PMID" : "4689829", "abstract" : "A drop attack was defined as falling without warning, not apparently due to any malfunction of the legs, not induced by change of posture or movement of the head, and not accompanied by vertigo or other cephalic sensation. All 33 patients attending a neurological clinic with a primary complaint fulfilling these criteria were women, and a further seven examples were found by questioning 200 consecutive patients at a gynaecological clinic. No affected male was found.In all but one patient, falls occurred only when walking. They were not due to wearing high-heeled shoes. The average age at onset was 44.5 years and in younger women onset was often during pregnancy. The accepted causes of drop attacks were not found with certainty in any of these patients. The sex incidence and the circumstances of the falls suggest that the cause may lie in differences between the two sexes in the mechanism of walking rather than in any central disturbance. Drop attacks in women commonly occur as an isolated symptom for many years, and although distressing have no serious prognostic implications.", "author" : [ { "dropping-particle" : "", "family" : "Stevens", "given" : "D L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matthews", "given" : "W B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British medical journal", "id" : "ITEM-1", "issue" : "February", "issued" : { "date-parts" : [ [ "1973", "2", "24" ] ] }, "page" : "439-42", "title" : "Cryptogenic drop attacks: an affliction of women.", "type" : "article-journal", "volume" : "1" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[1]", "plainTextFormattedCitation" : "[1]", "previouslyFormattedCitation" : "[1]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[1]. Drop attacks due to various disorders including cardiac, cerebrovascular causes, vestibular or, most commonly in children, seizure disordersADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/00016480701767390", "ISSN" : "0001-6489", "PMID" : "18607945", "abstract" : "CONCLUSION: The otolithic organs of patients with vestibular drop attack (VDA) secondary to Meniere's disease were damaged but the damage was not complete. In other words, the otolithic functions of patients with VDA were unstable. OBJECTIVE: To evaluate otolithic function using vestibular evoked myogenic potential (VEMP) in patients with VDA secondary to Meniere's disease. PATIENTS AND METHODS: Clinical records of three patients with VDA secondary to Meniere's disease were reviewed with special reference to VEMP testing. RESULTS: The three patients were classified as stage II or III Meniere's disease. A long-term follow-up of VEMP in two patients showed reversible changes of VEMP reflexes, and VEMP testing with glycerol administration in two patients revealed the recovery of VEMP responses after taking glycerol, and the existence of saccular endolymphatic hydrops.", "author" : [ { "dropping-particle" : "", "family" : "Ozeki", "given" : "Hidenori", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Iwasaki", "given" : "Shinichi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murofushi", "given" : "Toshihisa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Acta Oto-Laryngologica", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2008", "1", "8" ] ] }, "page" : "887-891", "title" : "Vestibular drop attack secondary to Meniere's disease results from unstable otolithic function", "type" : "article-journal", "volume" : "128" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1159/000260909", "ISSN" : "1423-0305", "PMID" : "19940537", "abstract" : "BACKGROUND: Chiari I malformation (CM1) is characterized by impaired CSF flow through the foramen magnum. Dysfunctional autonomic cardiovascular regulation may result in syncope. Syncope may be the primary presenting symptom of CM1: a syndrome termed Chiari drop attack. It has been postulated that Chiari drop attack is secondary to dysautonomia caused by hindbrain compression. There has been recent debate regarding the association between CM1, dysautonomia and Chiari drop attack. METHODS: We selected patients with Chiari drop attacks who had negative workups for cardiac syncope, followed by tilt table testing and subsequent surgical decompression. We report test results and clinical outcomes following CM1 decompression. RESULTS: Ten patients met the inclusion criteria: 5 patients had positive and 5 negative tilt table tests. Following decompression, 7 had symptomatic improvement or resolution and 3 failed to improve. The sensitivity and specificity of the tilt table test for detecting clinical improvement with surgical decompression was 43 and 33%, respectively. Tilt table testing had 40% accuracy in predicting clinical response to decompression. CONCLUSIONS: In this short series, surgical decompression of CM1 has a high success rate (70%) for patients with Chiari drop attacks. Tilt table testing has poor predictive value in judging the clinical response to surgical decompression and is not a useful test to guide surgical decision- making.", "author" : [ { "dropping-particle" : "", "family" : "Straus", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Foster", "given" : "Kimberly", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zimmerman", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Frim", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Pediatric Neurosurgery", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2009", "1" ] ] }, "page" : "384-389", "title" : "Chiari Drop Attacks: Surgical Decompression and the Role of Tilt Table Testing", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.seizure.2015.08.001", "ISSN" : "15322688", "abstract" : "Purpose We set out to determine clinical and EEG features of seizures presenting with falls, epileptic drop attacks and atonia in the video EEG monitoring unit. Methods We searched the video EEG monitoring reports over a 5-year-period for the terms \"drop\", \"fall\" and \"atonic\". Results Seizures presenting as epileptic drop attacks, falls or atonia were found in 23/1112 (2%) admissions. About half of the patients suffering from these seizure types had developmental delay and learning difficulties and in half of the patients a lesion was seen on MRI which was often frontal. The presumed epileptogenic zone was frontal in many cases (43%), unclear with regards to a region or multifocal in 48% and posterior temporal/occipital in 2 patients (9%). EEG patterns recorded were paroxysmal fast activity, spike and wave discharges and EEG attenuation. Seizure related falls were seen in 8 cases (34%) with injuries recorded during Video EEG monitoring in half of those. Conclusion Clinical and EEG features outlined here can help the clinician to recognise patients at risk for these devastating seizure types.", "author" : [ { "dropping-particle" : "", "family" : "Baraldi", "given" : "Sara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Farrell", "given" : "Fiona", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benson", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diehl", "given" : "Beate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wehner", "given" : "Tim", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kovac", "given" : "Stjepana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Seizure", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "4-8", "publisher" : "BEA Trading Ltd", "title" : "Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "ISSN" : "1760-1703", "PMID" : "16044488", "author" : [ { "dropping-particle" : "", "family" : "Parry", "given" : "Steve W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kenny", "given" : "Rose Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Psychologie & neuropsychiatrie du vieillissement", "id" : "ITEM-4", "issue" : "I", "issued" : { "date-parts" : [ [ "2005", "6" ] ] }, "page" : "137-138", "title" : "Drop attacks in older adults: systematic assessment has a high diagnostic yield", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[2\u20135]", "plainTextFormattedCitation" : "[2\u20135]", "previouslyFormattedCitation" : "[2\u20135]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[2–5] have been described since the early 1900sADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/WNL.36.8.1029", "ISSN" : "0028-3878", "PMID" : "3736867", "abstract" : "We grouped 108 patients with drop attacks, according to potential mechanisms based on predominant associated medical conditions, as follows: unknown, 69 (64%); cardiac, 13 (12%); cerebrovascular insufficiency, 9 (8%); combined cardiac and cerebrovascular disease, 8 (7%); seizures, 5 (5%); vestibular, 3 (3%); and psychogenic, 1 (1%). Fifty-four percent of the patients received no treatment, but similar percentages of treated (82%) and untreated (84%) patients were symptom-free at follow-up. The stroke rate in the overall group, approximately 0.5% per year, was not significantly different from that in a normal age- and sex-matched population. The favorable long-term outcome in drop attack patients with unrevealing medical and neurologic workups suggests that treatment is unwarranted for an isolated drop attack.", "author" : [ { "dropping-particle" : "", "family" : "Meissner", "given" : "I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wiebers", "given" : "D. O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swanson", "given" : "J. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "O'Fallon", "given" : "W. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurology", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "1986", "8", "1" ] ] }, "page" : "1029-1029", "title" : "The natural history of drop attacks", "type" : "article-journal", "volume" : "36" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.seizure.2015.08.001", "ISSN" : "15322688", "abstract" : "Purpose We set out to determine clinical and EEG features of seizures presenting with falls, epileptic drop attacks and atonia in the video EEG monitoring unit. Methods We searched the video EEG monitoring reports over a 5-year-period for the terms \"drop\", \"fall\" and \"atonic\". Results Seizures presenting as epileptic drop attacks, falls or atonia were found in 23/1112 (2%) admissions. About half of the patients suffering from these seizure types had developmental delay and learning difficulties and in half of the patients a lesion was seen on MRI which was often frontal. The presumed epileptogenic zone was frontal in many cases (43%), unclear with regards to a region or multifocal in 48% and posterior temporal/occipital in 2 patients (9%). EEG patterns recorded were paroxysmal fast activity, spike and wave discharges and EEG attenuation. Seizure related falls were seen in 8 cases (34%) with injuries recorded during Video EEG monitoring in half of those. Conclusion Clinical and EEG features outlined here can help the clinician to recognise patients at risk for these devastating seizure types.", "author" : [ { "dropping-particle" : "", "family" : "Baraldi", "given" : "Sara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Farrell", "given" : "Fiona", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benson", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diehl", "given" : "Beate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wehner", "given" : "Tim", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kovac", "given" : "Stjepana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Seizure", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "4-8", "publisher" : "BEA Trading Ltd", "title" : "Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "ISBN" : "0883-0738", "ISSN" : "0883-0738 (Print)", "PMID" : "15526963", "abstract" : "Subacute sclerosing panencephalitis can show variations in clinical course, and some ophthalmologic abnormalities can be seen as cortical blindness and optic atrophy. A 4-year-old girl was referred to our hospital with a complaint of diplopia, vomiting, and ataxia. On physical examination, she was found to have stage IV papilledema with retinal hemorrhage. She was diagnosed as having idiopathic intracranial high pressure until magnetic resonance imaging demonstrated T2-weighted hyperintense lesions. After observation of head drop attacks and detection of elevated antimeasles antibodies in cerebrospinal fluid, the diagnosis of subacute sclerosing panencephalitis was established, and isoprinosine and carbamazepine were started for treatment. However, because carbamazepine failed to control the head drop attacks, topiramate was also included, and the attacks were kept under control with topiramate. The case presented in this article is a good example of subacute sclerosing panencephalitis in which, at early stages, some of the signs and symptoms can lead to an erroneous diagnosis. In addition, we have demonstrated that topiramate might be a good choice for treatment for the persistent myoclonus seen in this type of patient.", "author" : [ { "dropping-particle" : "", "family" : "Duman", "given" : "Ozgur", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balta", "given" : "Gungor", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Metinsoy", "given" : "Mehmet", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Haspolat", "given" : "Senay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of child neurology", "id" : "ITEM-3", "issue" : "7", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "552-555", "title" : "Unusual manifestation of subacute sclerosing panencephalitis: case with intracranial high-pressure symptoms.", "type" : "article-journal", "volume" : "19" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1111/dmcn.12644", "ISBN" : "0012-1622", "ISSN" : "14698749", "abstract" : "Drop attacks are sudden, spontaneous falls without loss of consciousness, followed by rapid recovery. Causes in children include severe epilepsies, movement disorders, cataplexy, and psychiatric disorders. We describe two children (a 3\u2010year\u2010old female and a 12\u2010year\u2010old male) with mild neuromotor delay and sudden falls appearing upon starting to walk. Extensive clinical and laboratory investigation was unremarkable. Twenty to 22 months after the onset of falls, both children developed subtle choreiform movements, affecting all four limbs, leading to frequent falls, at times causing traumatic injury. A heterozygous mutation of the TITF1/NKX2\u20101 gene (14q13) was detected in both patients, allowing the diagnosis of benign hereditary chorea (BHC). Treatment with levodopa attenuated abnormal movements and led to disappearance of drop attacks. A diagnosis of BHC should be considered in young children with recurrent and unexplained drop attacks, especially if associated with neuromotor delay, even in the absence of choreiform movements. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)", "author" : [ { "dropping-particle" : "", "family" : "Rosati", "given" : "Anna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berti", "given" : "Beatrice", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Melani", "given" : "Federico", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cellini", "given" : "Elena", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Procopio", "given" : "Elena", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guerrini", "given" : "Renzo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Developmental Medicine and Child Neurology", "id" : "ITEM-4", "issue" : "8", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "777-779", "title" : "Recurrent drop attacks in early childhood as presenting symptom of benign hereditary chorea caused by TITF1 gene mutations", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1097/SCS.0b013e3181d7ae43", "ISSN" : "1049-2275", "PMID" : "20485083", "abstract" : "Histologically, nodular fasciitis is observed as similar to sarcoma in soft tissues, and it is referred to as pseudosarcomatous fasciitis. Its histologic findings can be summarized as spindle-shaped fibroblasts, intercellular space between fibroblasts, red blood cells released to the extravascular area, and deposition of mucus within the interstitium. The lesion looks similar to sarcoma histologically and shows the characteristic of rapid growth, which in result is readily misdiagnosed as malignancy. It occurs preferentially in the upper extremities, whereas rarely occurring in the head and neck region. When we encounter subcutaneous nodules of the head and neck region, it is important to keep nodular fasciitis in mind as a differential diagnosis to avoid unnecessary wide resection. In this article, we report a rare case of nodular fasciitis on the forehead and some reviews of the literature.", "author" : [ { "dropping-particle" : "", "family" : "Yeh", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chen", "given" : "W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huang", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chao", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lo", "given" : "Yi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Craniofacial Surgery", "id" : "ITEM-5", "issue" : "3", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "934-936", "title" : "Intracranial Brain Abscess Preceded by Ortbital Cellulitis and Sinusitis", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] }, { "id" : "ITEM-6", "itemData" : { "DOI" : "10.1007/s10072-011-0697-y", "ISBN" : "1590-1874", "ISSN" : "15903478", "PMID" : "21796429", "abstract" : "In patients with Chiari malformation type 1 (CMI), epileptic seizures are occasionally reported both in symptomatic patients candidate to surgery and in patients without symptoms of tonsillar displacement in whom CM1 is often an incidental finding in the diagnostic work up for idiopathic epilepsies. In both groups of patients, the course of epilepsy is almost invariably favorable, with a few seizures easily controlled by treatment. In a subset of CM1 patients, epilepsy occurs in the context of neurodevelopmental disorders that also include mental retardation, autism and somatic dysmorphisms. Epileptic seizures must be accurately differentiated by potentially harmful paroxysmal events due to compression of the medulla, particularly by the cerebellar fits characterized by drop attacks, abnormal extensor posturing and apnea. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)", "author" : [ { "dropping-particle" : "", "family" : "Granata", "given" : "Tiziana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Valentini", "given" : "Laura Grazia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurological Sciences", "id" : "ITEM-6", "issue" : "SUPPL. 3", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "303-306", "title" : "Epilepsy in type 1 Chiari malformation", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] }, { "id" : "ITEM-7", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Juvenile", "given" : "Ishii N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Molecular", "given" : "Navon R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-7", "issue" : "3", "issued" : { "date-parts" : [ [ "1994" ] ] }, "page" : "0-1", "title" : "\u201c Drop Attacks \u201d with Stiffening of the Right Leg Associated with Posterior Fossa Arachnoid Cyst Legend to the Videotape The videotape demonstrates a fall after rapid walking Are Lewy Bodies Non-specific Epiphenoma of Nigral Damage ?", "type" : "article-journal", "volume" : "9" }, "uris" : [ "" ] }, { "id" : "ITEM-8", "itemData" : { "DOI" : "", "ISBN" : "1641-4640\\r1509-572X", "ISSN" : "16414640", "PMID" : "2014015474", "abstract" : "We describe a child with dyslexia and difficulty in school who, at the age of 13 years, began to suffer from several head injuries resulting from falls of uncertain cause. Two years later, the patient developed symptoms of a severe mitochondrial disorder (involving bulbar-pyramidal paralysis, ophthalmoplegia, and hyperlactatemia) that coincided with VPA administration. Brain MR imaging revealed rapidly developing Leigh syndrome (LS), and muscle biopsy showed ragged blue fibres (RBF). A diminished expression of the E1\u03b1 subunit of pyruvate dehydrogenase was found in muscle homogenate (signal 28.7% of normal). The accurate diagnosis of mitochondrially inherited LS (MILS) and the identification of an almost homoplasmic m.8344G>A mutation in the MTTK gene was delayed due to an initial incorrect diagnosis of epilepsy, misdiagnosis of neuroinfection, and failure to note LS on the first brain MRI. Periods of exacerbation or improvement were observed in association with the administration of certain drugs or procedures (VPA administration or intensive rehabilitation associated with worsening; ketogenic diet associated with remission). However, the random association of these factors with natural disease fluctuations cannot be excluded. Conclusions: 1) To improve the early detection of mitochondrial disorder, we recommend screening for mtDNA (and nDNA) mutations in all patients with LS present on brain MRI. 2) Brain MRI protocols should include diffusion-weighted and T2-weighted imaging, and LS-like changes should be analysed by a neuroradiologist experienced in the field. 3) Additional controlled studies are urgently needed to assess the causal relationship between management strategies and the natural history of the disease. Until the association between VPA and disease exacerbation can be ruled out, VPA should be avoided in patients with these symptoms unless the mitochondrial disorder has been excluded.", "author" : [ { "dropping-particle" : "", "family" : "Buda", "given" : "Piotr", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Piekutowska-Abramczuk", "given" : "Dorota", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Karkucin\u0303ska-Wie\u0327ckowska", "given" : "Agnieszka", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jurkiewicz", "given" : "Elzbieta", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Che\u0142stowska", "given" : "Sylwia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pajdowska", "given" : "Magdalena", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Migda\u0142", "given" : "Marek", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ksia\u0327zyk", "given" : "Janusz", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kotulska", "given" : "Katarzyna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pronicka", "given" : "Ewa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Folia Neuropathologica", "id" : "ITEM-8", "issue" : "4", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "347-354", "title" : "\"Drop attacks\" as first clinical symptoms in a child carrying MTTK m.8344A>G mutation", "type" : "article-journal", "volume" : "51" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[4,6\u201312]", "plainTextFormattedCitation" : "[4,6\u201312]", "previouslyFormattedCitation" : "[4,6\u201312]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[4,6–12]. In their study of 40 patients with drop attacks Stevens and Matthews considered various mechanisms but concluded that this ‘cryptogenic’ presentation was the most common. Despite their prevalence, estimated at 3.5% of falls in adult womenADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.1.5851.439", "ISSN" : "0959-8138", "PMID" : "4689829", "abstract" : "A drop attack was defined as falling without warning, not apparently due to any malfunction of the legs, not induced by change of posture or movement of the head, and not accompanied by vertigo or other cephalic sensation. All 33 patients attending a neurological clinic with a primary complaint fulfilling these criteria were women, and a further seven examples were found by questioning 200 consecutive patients at a gynaecological clinic. No affected male was found.In all but one patient, falls occurred only when walking. They were not due to wearing high-heeled shoes. The average age at onset was 44.5 years and in younger women onset was often during pregnancy. The accepted causes of drop attacks were not found with certainty in any of these patients. The sex incidence and the circumstances of the falls suggest that the cause may lie in differences between the two sexes in the mechanism of walking rather than in any central disturbance. Drop attacks in women commonly occur as an isolated symptom for many years, and although distressing have no serious prognostic implications.", "author" : [ { "dropping-particle" : "", "family" : "Stevens", "given" : "D L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matthews", "given" : "W B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British medical journal", "id" : "ITEM-1", "issue" : "February", "issued" : { "date-parts" : [ [ "1973", "2", "24" ] ] }, "page" : "439-42", "title" : "Cryptogenic drop attacks: an affliction of women.", "type" : "article-journal", "volume" : "1" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[1]", "plainTextFormattedCitation" : "[1]", "previouslyFormattedCitation" : "[1]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[1], and their potential to be both embarrassing and fear inducing, no consecutive series of cryptogenic drop attacks in a predominantly middle age cohort has been undertaken since 1973ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/WNL.36.8.1029", "ISSN" : "0028-3878", "PMID" : "3736867", "abstract" : "We grouped 108 patients with drop attacks, according to potential mechanisms based on predominant associated medical conditions, as follows: unknown, 69 (64%); cardiac, 13 (12%); cerebrovascular insufficiency, 9 (8%); combined cardiac and cerebrovascular disease, 8 (7%); seizures, 5 (5%); vestibular, 3 (3%); and psychogenic, 1 (1%). Fifty-four percent of the patients received no treatment, but similar percentages of treated (82%) and untreated (84%) patients were symptom-free at follow-up. The stroke rate in the overall group, approximately 0.5% per year, was not significantly different from that in a normal age- and sex-matched population. The favorable long-term outcome in drop attack patients with unrevealing medical and neurologic workups suggests that treatment is unwarranted for an isolated drop attack.", "author" : [ { "dropping-particle" : "", "family" : "Meissner", "given" : "I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wiebers", "given" : "D. O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swanson", "given" : "J. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "O'Fallon", "given" : "W. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurology", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "1986", "8", "1" ] ] }, "page" : "1029-1029", "title" : "The natural history of drop attacks", "type" : "article-journal", "volume" : "36" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[6]", "plainTextFormattedCitation" : "[6]", "previouslyFormattedCitation" : "[6]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[6]. Several clinical observations in a series of patients with drop attacks led us to wonder whether some of them, especially in younger patients, may be considered a subtype of functional (psychogenic) neurological disorder. We hypothesize that a brief moment of dissociation, akin to that seen in dissociative (non-epileptic) attacks and/or sudden functional leg weakness, could be elicited as a conditioned response bound to the experience and subsequent fear of falling.We studied the clinical features and outcome of a retrospective consecutive series of patients with drop attacks to investigate this idea further.MATERIALS AND METHODSWe searched consecutive outpatient clinic letters for patients with ‘drop attacks’ from one neurologist (JS) with experience in the diagnosis of dissociative (non-epileptic) attacks, syncope, seizures and other causes of falls. All patients were referred to the Department of Clinical Neurosciences, Edinburgh, UK between 2007 and 2016 from one of three sources: an unselected primary care referral to a general neurology clinic which was randomly assigned to all general neurologists in the department; a clinic designed for the assessment of patients with functional disorders; or referred from colleagues due to a known research interest in patients with drop attacks.Patients were included in the study by the authors (other than JS), if they met a modified version of Stevens and Matthews’ definition of cryptogenic drop attacks: sudden fall to the ground, not caused by persistent leg weakness, change in posture or head position, nor accompanied by any vertiginous symptoms. Our modification was to include patients with intermittent functional leg weakness. We included those who could not remember the fall itself or who described finding themselves suddenly on the ground but not those who had a witnessed or perceived loss of consciousness. We included patients who had drop attacks even if it was not their primary neurological complaint. We excluded patients with prolonged loss of consciousness or responsiveness and cases when there was insufficient description of the attack itself. Dissociative (non-epileptic) seizures, including hypokinetic episodes (psychogenic pseudosyncope) and hyperkinetic episodes, were differentiated from drop attacks by the presence of reported or witnessed loss of consciousness or responsiveness with typical positive clinical features seen in those diagnosesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/jnnp.2009.197996", "ISBN" : "1468-330X (Electronic)\\r0022-3050 (Linking)", "ISSN" : "0022-3050", "PMID" : "20581136", "abstract" : "Psychogenic non-epileptic seizures (PNES) represent a diagnostic challenge. When trying to distinguish between PNES and epileptic seizures (ES), clinicians rely on the presence or absence of several clinical signs. The purpose of this review is to establish the extent to which these signs are supported by primary data from the literature. A Medline search was used to identify primary studies that used video-EEG to define the presence or absence of different clinical signs in PNES and ES. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. 34 studies matched the inclusion criteria. A specific sign was considered well supported by the data from the primary literature if we were able to identify at least two controlled studies demonstrating its usefulness and if the data from other studies were supportive. There is good evidence from the literature that long duration, occurrence from apparent sleep with EEG-verified wakefulness, fluctuating course, asynchronous movements, pelvic thrusting, side-to-side head or body movement, closed eyes during the episode, ictal crying, memory recall and absence of postictal confusion are signs that distinguish PNES from ES. Postictal stertorous breathing proved to distinguish convulsive PNES from generalised tonic clonic seizures (GTCS) and should be added to the list of useful clinical signs. The final clinical diagnosis should encompass all available data and should not rely on any single sign alone.", "author" : [ { "dropping-particle" : "", "family" : "Avbersek", "given" : "Andreja", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sisodiya", "given" : "Sanjay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of neurology, neurosurgery, and psychiatry", "id" : "ITEM-1", "issue" : "1468-330X (Electronic)", "issued" : { "date-parts" : [ [ "2010", "7" ] ] }, "language" : "eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Review SB - IM", "note" : "From Duplicate 2 (Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? - Avbersek, Andreja; Sisodiya, Sanjay)\n\nFrom Duplicate 2 (Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? - Avbersek, A; Sisodiya, S)\n\nDA - 20100628", "page" : "719-725", "publisher-place" : "Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK", "title" : "Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures?", "type" : "article-journal", "volume" : "81" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[13]", "plainTextFormattedCitation" : "[13]", "previouslyFormattedCitation" : "[13]" }, "properties" : { "noteIndex" : 4 }, "schema" : "" }[13]. We also excluded patients whose drop attacks were not cryptogenic, but included patients where comorbid medical diagnoses may have been contributing to the clinical picture but did not fully explain it. Drop attacks referred to in this study will refer to this definition unless otherwise specified.We retrospectively recorded data on age, gender, duration and frequency of attacks, and attack description including place, contextual use of medication, alcohol and drugs which may have caused the drop attack, injury, comorbid diagnoses including structural pathophysiological, functional somatic, functional neurological and psychiatric disorders from the medical notes and from JS’s review. Particular attention was paid to the presence of dissociative symptoms (such as depersonalisation and derealisation), situational triggers, the circumstances of the first attack and whether attacks changed over time. Comorbid symptoms and diagnoses were recorded as were radiological and cardiac investigations performed by the neurologists or other health professionals. We recorded the outcome of attacks and the development during follow-up of other conditions that, with the benefit of hindsight, might have explained the drop attacks. Follow up was based on electronic medical records in the host healthcare board, NHS Lothian, and five additional health boards in surrounding areas. A UK healthcare board is a connected set of hospitals and outpatient facilities where patients receive secondary level care. For patients from outside the host healthcare board and surrounding area, we attempted follow up via an additional, more limited, online health record system. Characteristics of patients referred to specialist or general clinics with drop attacks were compared using two-sided Chi-squared and t-testing. RESULTSParticipants and Demographics91 patients with drop attacks were diagnosed and seen by JS between January 2007-July 2016. Eight were excluded (drop attacks due to other causes (n=2), insufficient description of attacks (n=6)). For the remaining 83 patients, medical records were available for detailed review. Full electronic patient records documenting all hospital attendances were available for 67 patients who were referred from within NHS Lothian. Sixteen patients, referred from outside NHS Lothian underwent more limited notes review. Of 83 patients, the majority (n= 74, 89%) were female and mean age was 44yrs old (range 12-78yrs). Almost half of the patients (n=37, 44 %) were unselected referrals to a general neurology clinic (i.e. not specifically to JS), with the others divided almost equally between the functional disorders clinic (n=20) and those referred by other neurologists (n=26). Clinical features of attacks. Some of the key clinical features and their frequency is shown in Table 1Description of attack. Drop attacks, by definition, occurred suddenly, from standing or whilst walking. According to their records, the vast majority of patients (93%) could not remember the fall itself. Patients typically described finding themselves suddenly on the ground. All patients initially stated they had no warning. However, when asked specifically about symptoms of dissociation or panic 43% (n=36) of patients described a brief prodrome. This commonly consisted of depersonalisation and derealisation such as feeling “unplugged”, “floating” or a feeling of one of their legs not really belonging to them for only a second or two before the fall. Twenty-four (29%) patients had soft tissue injuries documented from the falls. More than half the patients with soft tissue injury had recurrent facial injuries indicating that they did not put their arms out to protect themselves (n=17). Injuries were also common to the knees (n=12). Eight patients (9%) had fracture of either a finger (n=3), ribs (n=2), an elbow, toe or wrist (all n=1). Unless they were injured, subjects were typically able to get up quickly but often reported being very embarrassed and worrying about future attacks.Frequency and duration. The mean duration of drop attacks when first seen at outpatient clinic was 56 months (range 2-388 months). There were three patterns of attacks: regular attacks occurring between ten times per day to once per month (n=34), clusters of attacks with freedom from attacks between clusters (n=6) and infrequent or solitary attacks (n=17).History of onset of attacks. In almost a quarter of patients (n=20, 24%) the first fall was reported as different from the subsequent drop attacks and was more likely a simple trip (n=11), vasovagal syncope (n=4), or associated with feeling generally unwell or dissociation (n=5).Triggers. 35% (n= 29) of patients noted drop attacks that were more likely to occur in certain situations or at certain times. These associations could be with places where they worried excessively about falling, such as on the stairs, in the bathroom or kitchen or only occurring outside, in the context of excessive noise or bright lights or when unaccompanied. In two cases the timing of the falls could be isolated to a short daily period (only occurring between 3-6pm in one patient and between 12-2am in another). Patients frequently expressed constant background concerns about falling with persistent and significant fear of injury and embarrassment. Seven patients with regular attacks described transient feelings of relief, or a feeling that, following an attack, they would be very unlikely to get another one for a few days, and indeed that prediction would usually be orbiditiesComorbid defined pathophysiological diseases at baseline: At baseline 12 patients (14%) had a potentially relevant comorbidity which may have increased their vulnerability to drop attacks, by either providing an initial or an ongoing physiological trigger for the attacks (epilepsy n=4, vertigo n=2, and one each of: asymptomatic pineal cyst with prior hydrocephalus and static neuroimaging >6years, Chiari malformation with foramen magnum decompression, basilar tip aneurysm coiling without evidence of clinical or radiological brainstem damage, left lacunar stroke which caused right sided weakness, type 1 diabetes but no evidence of hypoglyacemic events, hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformation). Comorbid functional and/or psychological disorders: Seventy-five patients (90%) had comorbid functional somatic disorder (n=68, 82%) or functional neurological symptom disorder (n=48, 51%) which typically overlapped. Somatic symptoms included: persistent fatigue (n=61, 73%), chronic pain (n= 33, 40%) and irritable bowel syndrome (n=12, 14%). 58% (n=48) of patients had a comorbid functional neurological symptom disorder: functional limb weakness (n=26, 31%), dissociative (non-epileptic) seizures (n=23, 28%), functional movement disorders (n=11, 13%) and other functional neurological symptoms affecting speech, vision or cognition (n=20, 24%). 23% (n=19) had episodes of dissociation without loss of consciousness, (i.e. episodes of gradual zoning out lasting several minutes with interruptibility). 74% of patients with comorbid dissociative (non-epileptic) seizures had them before the drop attacks and in 26% they developed after the drop attacks.Perhaps unsurprisingly, given the unpleasant and random nature of drop attacks, 43% (n= 36) of patients had a record of anxiety (n=23) or agoraphobia (n=13). Fifteen patients had depression (18%), three had bipolar affective disorder (one with comorbid schizoaffective disorder) and one patient had a diagnosis of post-traumatic stress disorder. We analysed referral bias as an explanation for comorbidity. Patients with drop attacks referred to an unselected general neurology service (i.e. not referred specifically to JS) had similarly high levels of functional somatic and functional neurological symptom disorders to those referred to a functional disorders clinic run by JS (Supplementary Table 1). Investigations86% (n=71) of patients had cardiac investigations, 77% (n=64) of patients had CT or MRI brain imaging and 23% (n=19) of patients had an EEG (Supplementary Table 2). Three patients had left their general practitioners and their cardiac investigations were impossible to trace. Of the 71 patients who had documented cardiac investigations, 34 were referred from either cardiology (n=15) or after normal 24-hour tape (n=19). Others had a mixture of investigations for cardiac causes of loss of consciousness including ECG plus a mixture of 24-hour blood pressure monitoring, echocardiography, tilt table testing (n=3) and implantable loop recorder (n=1). Six patients had their typical drop attacks during cardiac monitoring (n=4 telemetry, n= 1 implantable loop recorder, n=1 pacemaker) without cardiac abnormality. Three patients (4%) had neuroimaging abnormalities (n=1 cerebrovascular disease and atrophy in a patient subsequently diagnosed with frontotemporal dementia (FTD), n=1 previous posterior fossa craniectomy for Chiari malformation, n=1 small vessel ischaemic changes thought to be non-specific by consultant neuroradiologist).Prognosis and Treatment88% (n=73) patients had documented follow up with a mean duration of 38 months (median 29 months, range 0-115months). During follow up, until the end of July 2016, five patients developed a potentially relevant disease; dementia n=3 (FTD n=2, Alzheimer’s n=1), ischemic heart disease n=2, prolonged QTc n=1.Half of patients’ reported that their drop attacks (n=42, 51%) had either resolved (n=23, no attacks for at least 6 months) or reduced in frequency by the end of follow up. Almost a quarter had a static rate of attacks (n=18, 22%), 5% (n=4) were worse and 11% (n=9) had evolved into dissociative (non-epileptic) seizures. Only naturalistic data was available on treatment. Ten patients appeared to be treated effectively for their drop attacks, on the basis of episodes which resolved with distraction techniques and treatment based on a formulation of their symptoms as a conditioned response (see below). Patients without functional comorbidity Of the eight people without any functional disorder three were male, four had defined pathophysiological comorbidity (n=1 epilepsy and n=2 FTD, n=1 Hereditary hemorrhagic telangiectasisa with pulmonary arteriovenous malformation), and one man had events in the context of alcohol and nicotine excess. Four patients had resolution of drop attacks on follow up.DISCUSSIONThere are many clearly established causes of sudden falls with preserved consciousness including simple trips, knee instability, presyncope (and brief vasovagal syncope), arrhythmia and carotid sinus hypersensitivity, vertigo, cataplexy and colloid cyst of the third ventricle. The clinical features of alternate causes of drop attacks are addressed in other articles and summarized in Table 2 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00415-009-0108-y", "ISSN" : "1432-1459", "PMID" : "19271109", "abstract" : "In this practically oriented review, we will outline the clinical approach of patients with falls due to an impairment or loss of consciousness. Following a set of definitions, we describe the salient clinical features of disorders leading to such falls. Among falls caused by true loss of consciousness, we separate the clinical characteristics of syncopal falls (due to reflex syncope, hypovolemia, orthostatic hypotension or cardiac syncope) from falls due to other causes of transient unconsciousness, such as seizures. With respect to falls caused by an apparent loss of consciousness, we discuss the presentation of cataplexy, drop attacks, and psychogenic falls. Particular emphasis will be laid upon crucial features obtained by history taking for distinguishing between the various conditions that cause or mimic a transient loss of consciousness.", "author" : [ { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bloem", "given" : "Bastiaan R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "J Gert", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of neurology", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2009", "2" ] ] }, "page" : "155-67", "title" : "Falls, faints, fits and funny turns.", "type" : "article-journal", "volume" : "256" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/s11910-012-0278-3", "ISBN" : "1534-6293 (Electronic)\\r1528-4042 (Linking)", "ISSN" : "15284042", "PMID" : "22576731", "abstract" : "Psychogenic nonepileptic seizures (PNES) pose clinical challenges in terms of diagnosis and management. Recent studies have thrown further light on the extent to which features of PNES semiology may distinguish PNES patients from those with epilepsy. Management of this patient group will include discussion of the diagnosis, withdrawal of antiepileptic drugs, and psychological intervention when PNES persist. However, the evidence base for these different stages remains limited, although recent studies are beginning to provide guidance for clinicians and future research.", "author" : [ { "dropping-particle" : "", "family" : "Goldstein", "given" : "Laura H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mellers", "given" : "John D C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Current Neurology and Neuroscience Reports", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "436-444", "title" : "Recent developments in our understanding of the semiology and treatment of psychogenic nonepileptic seizures", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.yebeh.2007.11.006", "ISSN" : "15255050", "PMID" : "18164250", "abstract" : "Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures, but are not associated with ictal electrical discharges in the brain. PNES constitute one of the most important differential diagnoses of epilepsy. However, despite the fact they have been recognized as a distinctive clinical phenomenon for centuries and that access to video/EEG monitoring has allowed clinicians to make near-certain diagnoses for several decades, our understanding of the etiology, underlying mental processes, and, subsequently, subdifferentiation, nosology, and treatment remains seriously deficient. Emphasizing the clinical picture throughout, the first part of this article is intended to \"look and look again\" at what we know about the epidemiology, semiology, clinical context, treatment, and prognosis of PNES. The second part is dedicated to the questions that remain to be answered. It argues that the most important reason our understanding of PNES remains limited is the focus on the visible manifestations of PNES or the seizures themselves. In contrast, subjective seizure manifestations and the biographic or clinical context in which they occur have been relatively neglected", "author" : [ { "dropping-particle" : "", "family" : "Reuber", "given" : "Markus", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsy and Behavior", "id" : "ITEM-3", "issue" : "1525-5050 (Print)", "issued" : { "date-parts" : [ [ "2008", "5" ] ] }, "language" : "eng PT - Journal Article PT - Review SB - IM", "note" : "From Duplicate 2 (Psychogenic nonepileptic seizures: answers and questions - Reuber, M)\n\nDA - 20080324", "page" : "622-635", "publisher-place" : "Academic Neurology Unit, University of Sheffield/Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK. mreuber@.uk", "title" : "Psychogenic nonepileptic seizures: Answers and questions", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/l.2012.10.002", "ISSN" : "1558-2264", "PMID" : "23217692", "abstract" : "Carotid sinus hypersensitivity was first reported more than 200 years ago. Nevertheless, a complete understanding of this relatively common clinical finding in older patients has proven elusive. There is evidence to support an association between symptoms, particularly syncope, and a hypersensitive response to carotid sinus massage. However, the clinical implication of a high prevalence in asymptomatic healthy older persons is not known. A central degenerative process likely underlies the pathophysiology, but this is as yet unproven. Although selected patients have had symptom improvement with treatment, particularly permanent pacing, there is a dearth of randomized controlled trial data to guide management.", "author" : [ { "dropping-particle" : "", "family" : "Seifer", "given" : "Colette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiology clinics", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "2" ] ] }, "page" : "111-21", "title" : "Carotid sinus syndrome.", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "abstract" : "Meniere\u2019s disease is a chronic illness that aff ects a substantial number of patients every year worldwide. The disease is characterised by intermittent episodes of vertigo lasting from minutes to hours, with fl uctuating sensorineural hearing loss, tinnitus, and aural pressure. Although there is currently no cure, more than 85% of patients with Meniere\u2019s disease are helped by either changes in lifestyle and medical treatment, or minimally invasive surgical procedures such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. Vestibular neurectomy has a very high rate of vertigo control and is available for patients with good hearing who have failed all other treatments. Labyrinthectomy is undertaken as a last resort and is best reserved for patients with unilateral disease and deafness. Introduction", "author" : [ { "dropping-particle" : "", "family" : "Hain", "given" : "Timothy C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-5", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "406-14", "title" : "Meniere \u2019 s Disease", "type" : "article-journal", "volume" : "372" }, "uris" : [ "" ] }, { "id" : "ITEM-6", "itemData" : { "DOI" : "10.1097/00013414-200109000-00005", "ISSN" : "1050-6438", "author" : [ { "dropping-particle" : "", "family" : "Meadows", "given" : "Jeffery", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guarnieri", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Miller", "given" : "Ken", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Haroun", "given" : "Raymond", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kraut", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "Benjamin S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurosurgery Quarterly", "id" : "ITEM-6", "issue" : "3", "issued" : { "date-parts" : [ [ "2001", "9" ] ] }, "page" : "220-229", "title" : "Type I Chiari Malformation: A Review of the Literature", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] }, { "id" : "ITEM-7", "itemData" : { "ISSN" : "0090-3019", "PMID" : "12128295", "abstract" : "BACKGROUND: Colloid cyst of the third ventricle is a relatively rare intracranial tumor. It generates tremendous interest for the neurosurgeon because of its benign nature, deep location, and an excellent prognosis when diagnosed early and excised.\n\nMETHOD: A retrospective analysis of 105 cases of third ventricle colloid cyst treated between 1967 to 1998 was conducted. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. The transcallosal and transcortical-transventricular approaches were predominantly used. Memory and psychological assessment were carried out both pre- and postoperatively. A computerized tomography (CT) scan was performed during follow-up.\n\nRESULTS: The male to female ratio was 1.5:1. The age of the patients ranged from 10 to 68 years. Headache was the most common symptom. Papilledema and short-term memory disturbances were the most common signs. In 5 patients the colloid cyst was detected incidentally. Surgery for colloid cyst was performed in 93 patients. Transcallosal and transcortical-transventricular approaches were performed in 62 and 30 patients, respectively. In 1 patient the cyst was excised through the subfrontal lamina terminalis approach. Total excision was achieved in 90 patients, while partial cyst excision was done in three patients. Moderate to severe lateral ventricular enlargement was found in 76 patients at presentation. A ventriculoperitoneal shunt was the only surgical procedure performed in 7 patients. In 16 patients colloid cyst excision was conducted after cerebrospinal fluid (CSF) diversion via a shunt. No surgical treatment of any kind was performed in 5 patients. Five patients died. Eighty-six patients came for follow-up, with a range from 1 month to 25 years (average 3 years and 8 months). Postoperatively, transient recent memory deficits occurred in 14 patients, while a permanent recent memory loss was noted in 2 patients. There was no incidence of postoperative disconnection syndrome or behavioral disturbance. A CT scan was performed in 44 patients during follow-up. Recurrence was detected in 1 patient in whom the cyst had been partially excised.\n\nCONCLUSIONS: Colloid cyst, although a benign tumor, is surgically challenging because of its deep midline location. Early detection and total excision of the colloid cyst carries an excellent prognosis.", "author" : [ { "dropping-particle" : "", "family" : "Desai", "given" : "Ketan I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nadkarni", "given" : "Trimurti D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Muzumdar", "given" : "Dattatraya P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goel", "given" : "Atul H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgical neurology", "id" : "ITEM-7", "issue" : "5", "issued" : { "date-parts" : [ [ "2002", "5" ] ] }, "page" : "295-302; discussion 302-4", "title" : "Surgical management of colloid cyst of the third ventricle--a study of 105 cases.", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] }, { "id" : "ITEM-8", "itemData" : { "DOI" : "10.1111/j.1528-1167.2009.02231.x", "ISSN" : "00139580", "PMID" : "19702729", "abstract" : "Tonic and atonic seizures are typically seen in what are often referred to as the catastrophic epilepsies. In simply considering what each of the terms signifies (either the complete loss of tone or a marked increase in tone), they would appear to be at the most diverse ends of the spectrum. They would appear to be as opposite as hot and cold or hard and soft. And yet they are often found to occur in the same patient. This article examines the nature of these seizures and discusses some of the syndromes in which they are seen. Although these seizures are often very difficult to control, some of our medications/therapies have been shown to be effective. Recommendations concerning the efficacy of these therapies and a review of the newer therapies are provided. In addition, the ketogenic diet has been particularly successful in treating these seizures; this is discussed in some detail. Finally, although outcomes for these children are generally less than ideal, many can be helped with a persistent approach that balances seizure control against the side effects of medication.", "author" : [ { "dropping-particle" : "", "family" : "Vining", "given" : "Eileen P G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsia", "id" : "ITEM-8", "issue" : "SUPPL. 8", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "21-24", "title" : "Tonic and atonic seizures: Medical therapy and ketogenic diet", "type" : "article-journal", "volume" : "50" }, "uris" : [ "" ] }, { "id" : "ITEM-9", "itemData" : { "DOI" : "10.1016/j.carpath.2011.12.004", "ISBN" : "19362625", "ISSN" : "10548807", "PMID" : "22300501", "abstract" : "Background: Tumors of the heart are rare compared to other cardiac diseases. Their clinical symptoms vary from absent to nonspecific. This great variation and general paucity of symptoms related to cardiac tumors often result in delayed diagnosis and treatment. Methods: We retrospectively evaluated all patients who underwent cardiac surgery for a space-occupying lesion in the observation period between 2000 and 2010 at our hospital. Clinicopathological features, imaging characteristics, and disease outcomes were analyzed, and the results were compared with the available English literature. Results: During the last 10 years, 84 patients underwent resection of a cardiac mass at our center, i.e., 0.85% of the total number (n=9829) of all cardiac surgical operations performed in that period. The part of primary cardiac tumors was 73.8% (n=62; 59 benign and 3 malign tumors). In nine cases (10.7%), secondary cardiac tumors represented metastases of malignant tumors from different extracardiac locations. In 13 cases (15.5%), the mass represented cardiac thrombus. The majority of cardiac tumors were benign, and most of them were cardiac myxomas (n=48). Papillary fibroelastoma was the second most common primary tumor. Conclusions: Our data in this study were comparable to the literature regarding the frequency and allocation of the different cardiac tumors. Our data are in line with previous reports that patients with benign cardiac tumors profit from surgical resection compared to those subjected to conservative treatment with the risk of central or peripheral embolisms. Concerning malignant primary cardiac tumors and cardiac metastases, surgery represents only a palliative strategy in most of the cases. \u00a9 2012 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Strecker", "given" : "Thomas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "R\u00f6sch", "given" : "Johannes", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weyand", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Agaimy", "given" : "Abbas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovascular Pathology", "id" : "ITEM-9", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "436-443", "publisher" : "Elsevier Inc.", "title" : "Primary and metastatic cardiac tumors: Imaging characteristics, surgical treatment, and histopathological spectrum: A 10-year-experience at a German heart center", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] }, { "id" : "ITEM-10", "itemData" : { "DOI" : "10.1016/j.carpath.2013.04.006", "ISBN" : "1054-8807", "ISSN" : "10548807", "PMID" : "23727543", "abstract" : "Introduction: Primary cardiac tumors are rare entities with an autopsy frequency ranging between 0.001% and 0.3%. Our objective was to review 32 years of experience from a Spanish tertiary surgical center. Method: We collected data on 73 patients with a histopathological diagnosis of a primary cardiac tumor in a retrospective analysis from 1979 to 2012. Tissue samples were obtained either at surgery or from necropsy and subsequently divided into benign and malignant groups. Results: Benign neoplasms accounted for 84.9% of cases. The average age at diagnosis was 61 years, and tumors were twice as frequent among women. It was an incidental finding in one quarter of patients. In symptomatic patients, the typical presentation was of cardioembolic stroke or of congestive symptoms. Myxoma (93.5%) was the most common diagnosis, typically affecting the left atrium (74.2%). Surgical resection was curative for 95% of these patients. Malignant tumors represented 15.1% of cases with an average age at diagnosis of 50 years. Over 90% of these patients were symptomatic at presentation with the cardinal symptom being heart failure. Undifferentiated sarcoma was the most frequent malignant tumor (36.4%). Less than 20% of patients were alive 1 year after diagnosis despite the treatment. Conclusions: In our study, primary cardiac tumors were insidious. The most common was left atrial myxoma in which surgical resection was considered curative. Undifferentiated sarcoma was the most frequent malignant tumor. Malignant neoplasms carried a worse prognosis with unsuccessful total excision and the presence of metastatic disease being markers of an adverse outcome. ?? 2013 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Barreiro", "given" : "Manuel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Renilla", "given" : "Alfredo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jimenez", "given" : "Jaime M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Mar??a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Musa", "given" : "Tarique", "non-dropping-particle" : "Al", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garcia", "given" : "Laura", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barriales", "given" : "Vicente", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovascular Pathology", "id" : "ITEM-10", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "424-427", "publisher" : "Elsevier Inc.", "title" : "Primary cardiac tumors: 32 Years of experience from a Spanish tertiary surgical center", "type" : "article-journal", "volume" : "22" }, "uris" : [ "" ] }, { "id" : "ITEM-11", "itemData" : { "DOI" : "10.3233/JPN-2010-0354", "ISBN" : "1528-1167", "ISSN" : "13042580", "PMID" : "23153208", "abstract" : "Clinicians who diagnose and manage epilepsy frequently encounter diagnoses of a nonneurological nature, particularly when assessing patients with transient loss of consciousness (T-LOC). Among these, and perhaps the most important, is cardiac syncope. As a group, patients with cardiac syncope have the highest likelihood of subsequent sudden death, and yet, unlike sudden unexpected death in epilepsy (SUDEP) for example, it is the norm for these tragic occurrences to be both easily predictable and preventable. In the 12 months following initial presentation with cardiac syncope, sudden death has been found to be 6 times more common than in those with noncardiac syncope (N Engl J Med 309, 1983, 197). In short, for every patient seen with T-LOC, two fundamental aims of the consultation are to assess the likelihood of cardiac syncope as the cause, and to estimate the risk of future sudden death for the individual. This article aims to outline for the noncardiologist how to recognize cardiac syncope, how to tell it apart from more benign cardiovascular forms of syncope as well as from seizures and epilepsy, and what can be done to predict and prevent sudden death in these patients. This is achieved through the assessment triad of a clinical history and examination, risk stratification, and 12-lead electrocardiography (ECG).", "author" : [ { "dropping-particle" : "", "family" : "McLeod", "given" : "Karen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Pediatric Neurology", "id" : "ITEM-11", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "59-61", "title" : "Cardiac syncope", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] }, { "id" : "ITEM-12", "itemData" : { "DOI" : "10.1136/bmj.g6544", "ISBN" : "1756-1833 (Electronic) 0959-535X (Linking)", "ISSN" : "1756-1833", "PMID" : "25391837", "author" : [ { "dropping-particle" : "", "family" : "Harcourt", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barraclough", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bronstein", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ", "id" : "ITEM-12", "issue" : "nov12 9", "issued" : { "date-parts" : [ [ "2014", "11", "12" ] ] }, "page" : "g6544-g6544", "title" : "Meniere's disease", "type" : "article-journal", "volume" : "349" }, "uris" : [ "" ] }, { "id" : "ITEM-13", "itemData" : { "DOI" : "10.1056/NEJMra041544", "ISSN" : "1533-4406", "PMID" : "15972868", "author" : [ { "dropping-particle" : "", "family" : "Savitz", "given" : "Sean I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caplan", "given" : "Louis R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The New England journal of medicine", "id" : "ITEM-13", "issue" : "25", "issued" : { "date-parts" : [ [ "2005", "6", "23" ] ] }, "page" : "2618-26", "title" : "Vertebrobasilar disease.", "type" : "article-journal", "volume" : "352" }, "uris" : [ "" ] }, { "id" : "ITEM-14", "itemData" : { "DOI" : "10.1054/jocn.2000.0800", "ISSN" : "0967-5868", "PMID" : "11437572", "abstract" : "This paper is a retrospective review of all patients treated for a colloid cyst of the third ventricle at Royal Prince Alfred Hospital over an 18-year consecutive period. Our experience is fairly typical compared with other published series. Colloid cys ts made up 1.6% of tumours treated by the neurosurgical unit. Patients presented with non-specific neurological symptoms and signs, commonly suggestive of raised intracranial pressure. Microsurgical excision was carried out via the transcallosal route in 34 cases and the transfrontal approach in four cases. There was no apparent difference in results from the different surgical approaches. In 86% of patients reviewed after more than 6 months good long term outcome was achieved. These benign tumours can be safely cured if the diagnosis is made early and the cyst removed by careful microsurgical techniques.", "author" : [ { "dropping-particle" : "", "family" : "Jeffree", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Besser", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia", "id" : "ITEM-14", "issue" : "4", "issued" : { "date-parts" : [ [ "2001", "7" ] ] }, "page" : "328-31", "title" : "Colloid cyst of the third ventricle: a clinical review of 39 cases.", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] }, { "id" : "ITEM-15", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Quesney", "given" : "L F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "M", "given" : "Constain", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fish", "given" : "D R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "T", "given" : "Rasmussen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arch Neurol", "id" : "ITEM-15", "issue" : "6", "issued" : { "date-parts" : [ [ "1990" ] ] }, "page" : "677-9", "title" : "The clinical differentiation of seizures arising in the parasagittal and anterolaterodorsal frontal convexities", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] }, { "id" : "ITEM-16", "itemData" : { "DOI" : "10.1007/s10286-002-0051-9", "ISBN" : "0959-9851 (Print)\\r0959-9851 (Linking)", "ISSN" : "09599851", "PMID" : "12598952", "abstract" : "Orthostatic intolerance, seen predominantly in young women, is characterized by symptoms of lightheadedness, fatigue and palpitations in the upright posture. With standing, plasma norepinephrine levels rise dramatically and heart rate often increases by more than 30 beats per minute, although blood pressure does not usually fall. A theory recently popularized in the media suggests that some cases of orthostatic intolerance are related to hindbrain compression, with or without a Chiari I malformation. As a preliminary investigation of this hypothesis, head or cervical spine MRI scans from 23 females with orthostatic intolerance were reviewed. The cerebellar tonsils averaged 0.3 +/- 1.9 mm below the foramen magnum. These results were compared to measurements from a control group averaging 0.4 +/- 2.6 mm above the foramen magnum (P > 0.05). Tonsillar depression of at least 3 mm occurred in 13 % of both the patient group and the control group. Tonsillar herniation was not found to influence supine or upright blood pressure, heart rate or plasma norepinephrine levels in the patients. We conclude that herniation of the cerebellar tonsils is not a common cause of orthostatic intolerance. However, the single measurement of tonsillar depression might underestimate the number of patients with hindbrain compression.", "author" : [ { "dropping-particle" : "", "family" : "Garland", "given" : "Emily M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "James C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black", "given" : "Bonnie K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kessler", "given" : "Robert M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Konrad", "given" : "Peter E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Robertson", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Autonomic Research", "id" : "ITEM-16", "issue" : "6", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "472-476", "title" : "No increased herniation of the cerebellar tonsils in a group of patients with orthostatic intolerance", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-17", "itemData" : { "DOI" : "10.1016/j.surneu.2007.11.005", "ISBN" : "0090-3019 (Print)", "ISSN" : "00903019", "PMID" : "18295836", "abstract" : "Background: Colloid cysts are rare tumors (incidence 3.2/1 000 000 pear year) located in the anterosuperior part of the third ventricle. In this article, we present our microneurosurgical experience on 134 patients focusing on the nuances of ITA with demonstrative videoclips. Methods: This surgical series is based on the microsurgical experience of the senior author (JH) at 2 Finnish neurosurgical centers (Helsinki and Kuopio, 1980-2007). Surgical anatomy is demonstrated, and the pitfalls of the different surgical steps are analyzed to avoid complications. The series reflects the whole patient profile of Southern and Eastern Finland, without any selection bias. Results: There was no surgical mortality, and morbidity remained mainly transitory among 134 patients treated by ITA. Conclusions: Favorable overall outcome of this series demonstrates that removal of third ventricular colloid cyst via transcallosal approach is a direct and safe way to treat these lesions. \u00a9 2008.", "author" : [ { "dropping-particle" : "", "family" : "Hernesniemi", "given" : "Juha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Romani", "given" : "Rossana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dashti", "given" : "Reza", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albayrak", "given" : "Baki S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Savolainen", "given" : "Sakari", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ramsey", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Karatas", "given" : "Ayse", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lehto", "given" : "Hanna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Navratil", "given" : "Ondrej", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Niemel\u00e4", "given" : "Mika", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgical Neurology", "id" : "ITEM-17", "issue" : "5", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "447-453", "title" : "Microsurgical treatment of third ventricular colloid cysts by interhemispheric far lateral transcallosal approach-experience of 134 patients", "type" : "article-journal", "volume" : "69" }, "uris" : [ "" ] }, { "id" : "ITEM-18", "itemData" : { "DOI" : "10.1111/j.1528-1167.2011.03075.x", "ISSN" : "1528-1167", "PMID" : "21729037", "abstract" : "PURPOSE: Long-term medical management of epileptic drop attacks is usually unsatisfactory and more effective antiepileptic drug (AED) regimens are needed. The present study aimed at providing proof of concept that previously refractory epileptic drop attacks could be significantly and safely controlled by the specific combination of valproate, lamotrigine, and a benzodiazepine.\n\nMETHODS: An open label trial providing class IV evidence of efficacy, including 32 patients with cryptogenic/symptomatic, generalized or multifocal epilepsies, and refractory drop attacks. Following baseline, the combination under study was introduced and patients followed for 12 months. Frequency of drop attacks was compared at 3-month intervals with that during baseline and correlated with clinical, electroencephalography (EEG), and imaging variables. A list of putative side effects was read to patients and caregivers at each visit.\n\nKEY FINDINGS: Four patients were excluded, one due to a Stevens-Johnson syndrome (SJS). Median number of drop attacks decreased 96% between baseline and the fourth trimester of the study (from 50 to 2; p<0,001). Intention-to-treat (ITT) analysis showed that 15 patients (47%) had complete control, 7 (21%) had a 75% and 5 (15%) had a 50-74% reduction in the frequency of falls in the fourth trimester. Twenty-two patients (68%) had side effects, but except for the three excluded because of early rash, caregivers did not consider discontinuation. Mean final dose of valproate was 35.9 mg/kg/day and that of lamotrigine 4.9 mg/kg/day. Twenty patients used clobazam, eight nitrazepam, and the other four clonazepam as the elected benzodiazepine. Outcome did not correlate with clinical, EEG, and imaging variables.\n\nSIGNIFICANCE: This open label study suggests that the combination of valproate, lamotrigine, and a benzodiazepine can markedly reduce the frequency of epileptic drop attacks in patients with generalized or multifocal epilepsies. Careful clinical monitoring for early signs of SJS is needed.", "author" : [ { "dropping-particle" : "", "family" : "Machado", "given" : "Vitor Hugo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palmini", "given" : "Andre", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bastos", "given" : "Fernanda Almeida", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rotert", "given" : "Rosana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsia", "id" : "ITEM-18", "issue" : "7", "issued" : { "date-parts" : [ [ "2011", "7" ] ] }, "page" : "1303-10", "title" : "Long-term control of epileptic drop attacks with the combination of valproate, lamotrigine, and a benzodiazepine: a 'proof of concept,' open label study.", "type" : "article-journal", "volume" : "52" }, "uris" : [ "" ] }, { "id" : "ITEM-19", "itemData" : { "DOI" : "10.1016/j.ijcard.2008.11.103", "ISBN" : "0003-4932 (Print)\\r0003-4932 (Linking)", "ISSN" : "01675273", "PMID" : "19128845", "abstract" : "Primary cardiac tumors are a rare entity compared to tumors that metastasize to the heart. Patients with such tumors may be asymptomatic. Many cases are found incidentally during evaluation of an unrelated medical condition. It is important for the clinician to have a high index of suspicion when evaluating a patient presenting with signs and systemic symptoms concerning possible malignancy, plus cardiac specific symptoms or complications. These can include new onset dyspnea, congestive heart failure, arrhythmias or murmurs varying with body positions. Imaging, particularly the use of echocardiography, remains the cornerstone of diagnosis, and may be combined with new imaging modalities of cardiac CT and MRI. The aim of this paper is to describe the epidemiology and pathophysiology of the various benign and malignant primary cardiac tumors. ?? 2008 Elsevier Ireland Ltd. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Maraj", "given" : "Suraj", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pressman", "given" : "Gregg S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Figueredo", "given" : "Vincent M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Cardiology", "id" : "ITEM-19", "issue" : "2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "152-156", "publisher" : "Elsevier Ireland Ltd", "title" : "Primary Cardiac Tumors", "type" : "article-journal", "volume" : "133" }, "uris" : [ "" ] }, { "id" : "ITEM-20", "itemData" : { "DOI" : "10.1016/j.emc.2012.06.004", "ISSN" : "1558-0539", "PMID" : "22974644", "abstract" : "Dizzy patients present a significant diagnostic challenge to the emergency clinician. The discrimination between peripheral and central causes is important and will inform subsequent diagnostic evaluation and treatment. Isolated vertigo can be the only initial symptom of a posterior circulation stroke. The sensation of imbalance especially raises this possibility. Research involving strokes of the posterior circulation has lagged behind that of the anterior cerebral circulation. Investigations of the last 20 years, using new technologies in brain imaging in combination with detailed clinical studies, have revolutionized our understanding of the clinical presentation, causes, treatments, and prognosis of posterior circulation ischemia.", "author" : [ { "dropping-particle" : "", "family" : "Schneider", "given" : "Jeffrey I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olshaker", "given" : "Jonathan S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Emergency medicine clinics of North America", "id" : "ITEM-20", "issue" : "3", "issued" : { "date-parts" : [ [ "2012", "8" ] ] }, "page" : "681-93", "publisher" : "Elsevier Inc", "title" : "Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke.", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] }, { "id" : "ITEM-21", "itemData" : { "DOI" : "10.1001/archneur.60.1.71", "ISBN" : "0003-9942", "ISSN" : "0003-9942", "PMID" : "12533091", "abstract" : "BACKGROUND: Tumarkin falls are sudden drop-attack falls that occur in a subset of patients with Meniere syndrome (endolymphatic hydrops), an inner ear disorder characterized by vertigo spells and hearing loss. OBJECTIVE: To describe the clinical features and quantitative audiovestibular testing results in a case series of patients with Tumarkin falls, episodic vertigo, and normal hearing. SETTING: University referral center for disorders of balance and hearing. METHODS: Case series (unselected) of all patients with Tumarkin falls and a normal audiogram at least 1 year after onset of vestibular symptoms (n = 6) from a retrospective analysis of the records of all patients with Tumarkin falls presenting to Neurotology Clinic at UCLA Medical Center, Los Angeles, Calif, from October 1, 1975, to February 1, 2001 (N = 55). Quantitative audiologic and vestibular function testing, neurologic history, and examination were performed. RESULTS: Five of 6 patients had unilateral caloric paresis, and 1 had bilateral vestibulopathy. Five of 6 had a personal and/or family history of migraine headaches meeting International Headache Society criteria. All patients had a subjective sensation of feeling pushed by an external force, and half of the patients had a subjective tilt of the environment concurrent with the fall. CONCLUSIONS: The incidence of migraine is high in this subgroup of patients with Tumarkin falls and normal hearing. The clinical description of the falls is similar to those associated with Meniere syndrome. Further studies are needed to understand the etiology of Tumarkin falls in these patients with normal hearing.", "author" : [ { "dropping-particle" : "", "family" : "Ishiyama", "given" : "Gail", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ishiyama", "given" : "Akira", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baloh", "given" : "Robert W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Archives of neurology", "id" : "ITEM-21", "issue" : "1", "issued" : { "date-parts" : [ [ "2003" ] ] }, "page" : "71-75", "title" : "Drop attacks and vertigo secondary to a non-meniere otologic cause.", "type" : "article-journal", "volume" : "60" }, "uris" : [ "" ] }, { "id" : "ITEM-22", "itemData" : { "DOI" : "10.1016/S0749-0690(02)00002-2", "ISBN" : "0749-0690 (Print)\\r0749-0690 (Linking)", "ISSN" : "07490690", "PMID" : "12180240", "abstract" : "Falls, syncope, and the associated complications are among the most serious problems that face the elderly population. The most common underlying causes and risk factors for falls include muscle weakness, gait and balance problems, visual impairment, cognitive impairment, depression, functional decline, and particular medications (especially in the presence of environmental hazards). Studies have identified the relative risks for these factors that enable a fairly accurate prediction of who is at high risk for falls and what areas to target for falls-prevention activity. Causes and risk factors for syncope have not been studied as well in the older population. The most serious types of syncope have underlying cardiac etiologies but they cause less than 25% of the reported cases. The largest category of syncope (approximately 40%) is syncope of unknown etiology, which defies careful diagnostic evaluation but seems to be fairly benign. The epidemiology of these syndromes can provide extremely helpful insights for developing falls-prevention strategies.", "author" : [ { "dropping-particle" : "", "family" : "Rubenstein", "given" : "Laurence Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Josephson", "given" : "Karen R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in geriatric medicine", "id" : "ITEM-22", "issue" : "2", "issued" : { "date-parts" : [ [ "2002", "5" ] ] }, "note" : "Ref 91 and 99 post-fall anxiety", "page" : "141-58", "title" : "The epidemiology of falls and syncope.", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[14\u201335]", "plainTextFormattedCitation" : "[14\u201335]", "previouslyFormattedCitation" : "[14\u201335]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[14–35].The consideration that cryptogenic drop attacks in the majority of patients may be due to a pathophysiological disorder causing brief loss of consciousness is warranted ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/WNL.0000000000003361", "ISBN" : "0000000000", "ISSN" : "1526-632X (Electronic)", "PMID" : "27784771", "abstract" : "OBJECTIVE: To determine the outcome of patients with psychogenic pseudosyncope (PPS) after communication of the diagnosis. METHODS: This was a retrospective cohort study of patients with PPS referred in 2007 to 2015 to a tertiary referral center for syncope. We reviewed patient records and studied attack frequency, factors affecting attack frequency, health care use, and quality of life using a questionnaire. We explored influences on attack freedom and attack frequency in the 6 months before follow-up for age, sex, education level, duration until diagnosis, probability of diagnosis, additional syncope, and acceptance of diagnosis. RESULTS: Forty-seven of 57 patients with PPS could be traced, of whom 35 (74%) participated. Twelve (34%) were attack-free for at least 6 months. The median time from diagnosis to follow-up was 50 months (range 6-103 months). Communicating and explaining the diagnosis resulted in immediate reduction of attack frequency (p = 0.007) from the month before diagnosis (median one attack, range 0-156) to the month after (median one attack, range 0-16). In the 6 months before follow-up, the number of admissions decreased from 19 of 35 to 0 of 35 (p = 0.002). The use of somatic and mental health care shifted toward the latter (p < 0.0001). Quality of life at follow-up (Short Form Health Survey 36) showed lower scores for 7 of 8 domains compared to matched Dutch control values; quality of life was not influenced by attack freedom. CONCLUSIONS: After communication of the diagnosis in PPS, attack frequency decreased and health care use shifted toward mental care. Low quality of life underlines that PPS is a serious condition.", "author" : [ { "dropping-particle" : "", "family" : "Saal", "given" : "Dirk P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Overdijk", "given" : "M Jolein", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vliet", "given" : "Irene M", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "J Gert", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurology", "id" : "ITEM-1", "issue" : "21", "issued" : { "date-parts" : [ [ "2016", "11", "22" ] ] }, "page" : "2214-2219", "publisher" : "Lippincott Williams & Wilkins", "title" : "Long-term follow-up of psychogenic pseudosyncope.", "type" : "article-journal", "volume" : "87" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.yebeh.2016.06.027", "ISBN" : "1531-8249", "ISSN" : "15255069", "PMID" : "27486953", "abstract" : "We sought to characterize the clinical features of tilt-induced psychogenic nonsyncopal collapse (PNSC) from a cohort of young patients and to compare the semiologies between PNSC and EEG-confirmed psychogenic nonepileptic seizures (PNES). A PNSC diagnosis was made if a clinical event occurred during tilt-table testing that the patient regarded as fainting, but neither hypotension nor EEG changes were present. A diagnosis of PNSC was made in 17.6% of all patients referred during the 15-month study period. Cohorts with psychogenic nonsyncopal collapse (n = 40) and PNES (n = 40) did not differ in age (15.5 \u00b1 2.2 versus 14.6 \u00b1 2.7, p = .11) or female gender (80% versus 72.5%, p = .43). Psychogenic nonsyncopal collapse events were briefer than PNES events (median: 45 versus 201.5 s, p < .001). Negative motor signs (head drop, body limpness) predominated in PNSC (85% versus 20%, p < .001), while the positive motor signs of convulsion occurred more often with PNES (90% versus 30%, p < .001). Behavioral arrest (25% versus 32.5%, p = .46) and eye closure (85% versus 72.5%, p = .21) did not differ between PNSC and PNES. Patients with PNSC were more likely to be tearful before (30% versus 7.5%, p = .02) and after (62.5% versus 7.5%, p < .001) an event. In conclusion, although overlap exists, the features of PNSC generally appear similar to neurally mediated syncope, while the features of PNES generally appear similar to epileptic seizures. Psychogenic nonsyncopal collapse and PNES likely represent similar disorders that differ primarily by clinical semiologies and referral patterns.", "author" : [ { "dropping-particle" : "", "family" : "Heyer", "given" : "Geoffrey L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albert", "given" : "Dara V.F.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weber", "given" : "Amanda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gedela", "given" : "Satyanarayana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vidaurre", "given" : "Jorge", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsy and Behavior", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "171-175", "title" : "Comparison of semiologies between tilt-induced psychogenic nonsyncopal collapse and psychogenic nonepileptic seizures", "type" : "article-journal", "volume" : "62" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[36,37]", "plainTextFormattedCitation" : "[36,37]", "previouslyFormattedCitation" : "[36,37]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[36,37]. Syncope can present without prodrome or with amnesia for the event. Although any type of syncope can occur without prodrome, arrhythmic cardiac syncope and cardioinhibitory reflex syncope are perhaps most likely to be associated with a rapid onset of unconsciousness and are the main pathophysiological differential diagnosis for cryptogenic drop attacksADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00415-009-0108-y", "ISSN" : "1432-1459", "PMID" : "19271109", "abstract" : "In this practically oriented review, we will outline the clinical approach of patients with falls due to an impairment or loss of consciousness. Following a set of definitions, we describe the salient clinical features of disorders leading to such falls. Among falls caused by true loss of consciousness, we separate the clinical characteristics of syncopal falls (due to reflex syncope, hypovolemia, orthostatic hypotension or cardiac syncope) from falls due to other causes of transient unconsciousness, such as seizures. With respect to falls caused by an apparent loss of consciousness, we discuss the presentation of cataplexy, drop attacks, and psychogenic falls. Particular emphasis will be laid upon crucial features obtained by history taking for distinguishing between the various conditions that cause or mimic a transient loss of consciousness.", "author" : [ { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bloem", "given" : "Bastiaan R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "J Gert", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of neurology", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2009", "2" ] ] }, "page" : "155-67", "title" : "Falls, faints, fits and funny turns.", "type" : "article-journal", "volume" : "256" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1038/nrneurol.2009.99", "ISBN" : "1759-4758", "ISSN" : "1759-4758", "PMID" : "19597513", "abstract" : "Episodes of transient loss of consciousness (TLOC) events pose diagnostic difficulties, as the causes are diverse, carry vastly different risks, and span various specialties. An inconsistent terminology contributes to the confusion. Here, we present a classification scheme for TLOC, based on ongoing multidisciplinary efforts including those of the Task Force on Syncope of the European Society of Cardiology. We also discuss the pathophysiology of TLOC and the key clinical features that aid diagnosis. TLOC is defined as an apparent loss of consciousness with an abrupt onset, a short duration, and a spontaneous and complete recovery. Syncope is defined as TLOC due to cerebral hypoperfusion, and is divided into reflex syncope (synonymous with neurally mediated syncope), syncope due to orthostatic hypotension, and cardiac syncope (arrhythmic or associated with structural cardiac disease). The other major groups of TLOC are generalized epileptic seizures, functional TLOC (psychogenic TLOC mimicking either epilepsy or syncope), and a further group of miscellaneous disorders. The management of patients who experience TLOC requires the recognition of the defining features of each of the major groups, and cooperation between different clinical specialties.", "author" : [ { "dropping-particle" : "", "family" : "Dijk", "given" : "J Gert", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benditt", "given" : "David G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wieling", "given" : "Wouter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nature reviews. Neurology", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "438-448", "title" : "A guide to disorders causing transient loss of consciousness: focus on syncope.", "type" : "article-journal", "volume" : "5" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[14,38]", "plainTextFormattedCitation" : "[14,38]", "previouslyFormattedCitation" : "[14,38]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[14,38]. In patients with syncope, amnesia for the loss of consciousness can be present, occurring in 25- 28% of predominantly older patients (>60yrs) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/europace/eur069", "ISSN" : "10995129", "PMID" : "21436135", "abstract" : "AIMS: The aim of this study was to determine the prevalence of amnesia for loss of consciousness (A-LOC) in those who have a history suggestive of vasovagal syncope (VVS) and who develop syncope on head-up tilt (HUT) table testing. Furthermore, we wished to determine if A-LOC is an age-dependent phenomenon in VVS and whether haemodynamic parameters on tilting can predict for A-LOC., METHODS AND RESULTS: Patients were recruited in a dedicated syncope unit and underwent neurocardiovascular evaluation as indicated under European Society of Cardiology guidelines to illicit a diagnosis of VVS. A set protocol of questioning occurred following induced syncope to determine the presence of A-LOC. The prevalence of A-LOC following syncope on tilting was 28% (44/159). Forty-two per cent of those>60 years of age vs. 20%<60 years of age experienced amnesia post-induced syncope (P=0.003). However, regression analysis did not show age to be an independent predictor for A-LOC. Blood pressure change between those without amnesia and those with amnesia showed no significant difference (P=0.687). There was a significant difference in heart rate response; those experiencing amnesia had reduced bradycardic response on HUT compared with those without amnesia (P=0.001)., CONCLUSION: Amnesia for loss of consciousness is common in VVS. Although more prevalent, it is not unique to older age-groups. Absence of syncope associated bradycardia during HUT testing predicts for A-LOC.", "author" : [ { "dropping-particle" : "", "family" : "O'Dwyer", "given" : "Clodagh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bennett", "given" : "Kathleen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langan", "given" : "Yvonne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fan", "given" : "Chie Wei", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kenny", "given" : "Rose Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Europace", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2011" ] ] }, "note" : "158 LOC mean age 47 mostly female (71%) \n\namnesia for LOC in 44/159 (28%) mostly >60yrs old", "page" : "1040-1045", "title" : "Amnesia for loss of consciousness is common in vasovagal syncope", "type" : "article-journal", "volume" : "13" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[39]", "plainTextFormattedCitation" : "[39]", "previouslyFormattedCitation" : "[39]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[39]. Additionally, some patients with provoked syncope may describe dissociative symptoms including an ‘out of body’ experience (9%). However, we propose that the very brief duration of cryptogenic drop attacks is the key distinguishing feature. Patients with cryptogenic drop attacks are alert until the start of the fall and immediately again on hitting the ground, meaning any loss of consciousness or awareness in drop attacks must be less only a second or two. In any cardiac induced loss of consciousness it usually takes seconds to lose consciousness and also seconds to regain itADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/WNL.0b013e3182a1aa88", "ISBN" : "0028-3878", "ISSN" : "00283878", "PMID" : "23873974", "abstract" : "OBJECTIVES: To provide a detailed semiology to aid the clinical recognition of psychogenic pseudosyncope (PPS), which concerns episodes of apparent transient loss of consciousness (TLOC) that mimic syncope. METHODS: We analyzed all consecutive tilt-table tests from 2006 to 2012 showing proven PPS, i.e., apparent TLOC had occurred without EEG changes or a decrease in heart rate (HR) or blood pressure (BP). We analyzed baseline characteristics, video data, EEG, ECG, and continuous BP measurements on a 1-second time scale. Data were compared with those of 69 cases of tilt-induced vasovagal syncope (VVS). RESULTS: Of 800 tilt-table tests, 43 (5.4%) resulted in PPS. The majority (74%) were women. The median duration of apparent TLOC was longer in PPS (44 seconds) than in VVS (20 seconds, p < 0.05). During the event, the eyes were closed in 97% in PPS but in only 7% in VVS (p < 0.0001). A sudden head drop or moving down the tilt table was more common in PPS than in VVS (p < 0.01), but jerking movements occurred more frequently in VVS (p < 0.0001). In PPS, both HR and BP increased before and during apparent TLOC (p < 0.0001). CONCLUSIONS: PPS is clinically distinct from VVS and can be diagnosed accurately with tilt-table testing and simultaneous EEG monitoring. Compared with VVS, eye closure during the event, long periods of apparent TLOC, and high HR and BP are highly specific for PPS. Improved understanding of the semiology of PPS as a clinical entity is vital to ensure accurate diagnosis.", "author" : [ { "dropping-particle" : "", "family" : "Tannemaat", "given" : "Martijn R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Niekerk", "given" : "Julius", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reijntjes", "given" : "Robert H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sutton", "given" : "Richard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "J. Gert", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurology", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "752-758", "title" : "The semiology of tilt-induced psychogenic pseudosyncope", "type" : "article-journal", "volume" : "81" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1093/brain/awp179", "ISSN" : "00068950", "PMID" : "19587129", "abstract" : "Detailed history taking is of paramount importance to establish a reliable diagnosis in patients with transient loss of consciousness. In this article the clinical symptoms and signs of the successive phases of a syncopal episode are reviewed. A failure of the systemic circulation to perfuse the brain sufficiently results in a stereotyped progression of neurological symptoms and signs culminating in loss of consciousness; when transient, this is syncope. Prior to loss of consciousness the affected individual tends to exhibit unclear thinking, followed by fixation of the eyes in the midline and a 'frozen' appearance. Narrowing of the field of vision with loss of colour vision ('greying' out) and finally a complete loss of vision (hence 'blacking' out) occurs. Hearing loss may occur following loss of vision. This process may take as little as approximately 7 s in cases of sudden complete circulatory arrest (e.g. abrupt asystole), but in other circumstances it may take longer depending on the rate and depth of cerebral hypoperfusion. Complete loss of consciousness occurs with the 'turning up' of the eyeballs. Profound cerebral hypoperfusion may be accompanied by myoclonic jerks.", "author" : [ { "dropping-particle" : "", "family" : "Wieling", "given" : "Wouter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "N.", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilde", "given" : "Arthur a M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benditt", "given" : "David G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "J. Gert", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Brain", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "2630-2642", "title" : "Symptoms and signs of syncope: A review of the link between physiology and clinical clues", "type" : "article-journal", "volume" : "132" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[40,41]", "plainTextFormattedCitation" : "[40,41]", "previouslyFormattedCitation" : "[40,41]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[40,41]. We suggest that the very brief loss of awareness in cryptogenic drop attacks is too short to be due to cerebral hypoperfusion, whilst accepting that it could be in the realms of a complicated pre-syncopal episode.Functional neurological disorders are defined as those in which patients have motor or sensory symptoms which can be clearly identified as internally inconsistent or incongruous with disease on the basis of positive signs such as Hoover’s sign or tremor entrainment testADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/01.CON.0000466669.02477.45", "ISBN" : "1080-2371", "ISSN" : "1080-2371", "PMID" : "26039857", "author" : [ { "dropping-particle" : "", "family" : "Stone", "given" : "Jon", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "Alan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Continuum (Minneap Minn)", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "818-837", "title" : "Functional Neurologic Disorders", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[42]", "plainTextFormattedCitation" : "[42]", "previouslyFormattedCitation" : "[42]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[42]. These highlight the fact that functional motor symptoms are normally maintained by excessive attention paid to the limb which in turn interferes with normal voluntary movement ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/brain/awr292", "ISBN" : "1460-2156 (Electronic)\\r0006-8950 (Linking)", "ISSN" : "0006-8950", "PMID" : "22075068", "abstract" : "We assessed the duration and severity of tremor in a real-life ambulatory setting in patients with psychogenic and organic tremor by actigraphy, and compared this with self-reports of tremor over the same period. Ten participants with psychogenic tremor and eight with organic tremor, diagnosed using standardized clinical criteria, were studied. In an explicit design, participants were asked to wear a small actigraph capable of continuously monitoring tremor duration and intensity for 5 days while keeping a diary of their estimates of tremor duration during the same period. Eight patients with psychogenic tremor and all patients with organic tremor completed the study. Psychogenic patients reported significantly more of the waking day with tremor compared with patients with organic tremor (83.5 \u00b1 14.0% of the waking day versus 58.0 \u00b1 19.0% of the waking day; P < 0.01), despite having almost no tremor recorded by actigraphy (3.9 \u00b1 3.7% of the waking day versus 24.8 \u00b1 7.7% of the waking day; P = 0.001). Patients with organic tremor reported 28% more tremor than actigraphy recordings, whereas patients with psychogenic tremor reported 65% more tremor than actigraphy. These data demonstrate that patients with psychogenic tremor fail to accurately perceive that they do not have tremor most of the day. The explicit study design we employed does not support the hypothesis that these patients are malingering. We discuss how these data can be understood within models of active inference in the brain to provide a neurobiological framework for understanding the mechanism of psychogenic tremor.", "author" : [ { "dropping-particle" : "", "family" : "Parees", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Saifee", "given" : "Tabish a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kassavetis", "given" : "Panagiotis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kojovic", "given" : "Maja", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rubio-Agusti", "given" : "Ignacio", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rothwell", "given" : "John C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bhatia", "given" : "Kailash P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Edwards", "given" : "Mark J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Brain", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2012", "1", "1" ] ] }, "language" : "eng PT - Journal Article PT - Research Support, Non-U.S. Gov't SB - AIM SB - IM", "note" : "From Duplicate 3 (Believing is perceiving: mismatch between self-report and actigraphy in psychogenic tremor - Parees, I; Saifee, T A; Kassavetis, P; Kojovic, M; Rubio-Agusti, I; Rothwell, J C; Bhatia, K P; Edwards, M J)\n\nDA - 20120130", "page" : "117-123", "publisher-place" : "Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK", "title" : "Believing is perceiving: mismatch between self-report and actigraphy in psychogenic tremor", "type" : "article-journal", "volume" : "135" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1097/WCO.0b013e3283633953", "ISSN" : "1473-6551", "PMID" : "23823467", "abstract" : "PURPOSE OF REVIEW: This review explores recent developments in understanding the neurobiological mechanism of functional (psychogenic) movement disorders (FMDs). This is particularly relevant given the resurgence of academic and clinical interest in patients with functional neurological symptoms and the clear shift in diagnostic and treatment approaches away from a pure psychological model of functional symptoms.\\n\\nRECENT FINDINGS: Recent research findings implicate three key processes in the neurobiology of FMD (and by extension other functional neurological symptoms): abnormal attentional focus, abnormal beliefs and expectations, and abnormalities in sense of agency. These three processes have been combined in recent neurobiological models of FMD in which abnormal predictions related to movement are triggered by self-focused attention, and the resulting movement is generated without the normal sense of agency that accompanies voluntary movement.\\n\\nSUMMARY: New understanding of the neurobiology of FMD forms an important part of reappraising the way that patients with FMD (and other functional disorders) are characterized and treated. It also provides a testable framework for further exploring the pathophysiology of these common causes of ill health.", "author" : [ { "dropping-particle" : "", "family" : "Edwards", "given" : "Mark J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fotopoulou", "given" : "Aikaterini", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pare\u00e9s", "given" : "Isabel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Current opinion in neurology", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "442-7", "title" : "Neurobiology of functional (psychogenic) movement disorders.", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1093/brain/aws129", "ISBN" : "0006-8950\\r1460-2156", "ISSN" : "00068950", "PMID" : "22641838", "abstract" : "This article provides a neurobiological account of symptoms that have been called 'hysterical', 'psychogenic' or 'medically unexplained', which we will call functional motor and sensory symptoms. We use a neurobiologically informed model of hierarchical Bayesian inference in the brain to explain functional motor and sensory symptoms in terms of perception and action arising from inference based on prior beliefs and sensory information. This explanation exploits the key balance between prior beliefs and sensory evidence that is mediated by (body focused) attention, symptom expectations, physical and emotional experiences and beliefs about illness. Crucially, this furnishes an explanation at three different levels: (i) underlying neuromodulatory (synaptic) mechanisms; (ii) cognitive and experiential processes (attention and attribution of agency); and (iii) formal computations that underlie perceptual inference (representation of uncertainty or precision). Our explanation involves primary and secondary failures of inference; the primary failure is the (autonomous) emergence of a percept or belief that is held with undue certainty (precision) following top-down attentional modulation of synaptic gain. This belief can constitute a sensory percept (or its absence) or induce movement (or its absence). The secondary failure of inference is when the ensuing percept (and any somatosensory consequences) is falsely inferred to be a symptom to explain why its content was not predicted by the source of attentional modulation. This account accommodates several fundamental observations about functional motor and sensory symptoms, including: (i) their induction and maintenance by attention; (ii) their modification by expectation, prior experience and cultural beliefs and (iii) their involuntary and symptomatic nature", "author" : [ { "dropping-particle" : "", "family" : "Edwards", "given" : "Mark J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Adams", "given" : "Rick a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "Harriet", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pare\u00e9s", "given" : "Isabel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Friston", "given" : "Karl J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parees", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Friston", "given" : "Karl J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Brain", "id" : "ITEM-3", "issue" : "1460-2156 (Electronic)", "issued" : { "date-parts" : [ [ "2012", "11", "28" ] ] }, "language" : "ENG PT - JOURNAL ARTICLE", "note" : "From Duplicate 1 (A Bayesian account of 'hysteria' - Edwards, M J; Adams, R A; Brown, H; Parees, I; Friston, K J)\n\nDA - 20120529\n\nFrom Duplicate 2 (A Bayesian account of 'hysteria' - Edwards, M J; Adams, R A; Brown, H; Parees, I; Friston, K J)\n\nDA - 20121121", "page" : "3495-3512", "publisher-place" : "1 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, UK", "title" : "A Bayesian account of 'hysteria'", "type" : "article-journal", "volume" : "135" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[43\u201345]", "plainTextFormattedCitation" : "[43\u201345]", "previouslyFormattedCitation" : "[43\u201345]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[43–45]. The symptoms are experienced as involuntary and may or may not be associated with psychological comorbidity or prior psychosocial stress. Research on functional/psychogenic causes of brief loss of consciousness such as psychogenic pseudosyncope and dissociative (non-epileptic) seizures highlight evidence that many patients experience dissociative responses as a conditioned response to autonomic arousal that occurs suddenly and briefly prior to their events ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/WNL.0000000000003361", "ISBN" : "0000000000", "ISSN" : "1526-632X (Electronic)", "PMID" : "27784771", "abstract" : "OBJECTIVE: To determine the outcome of patients with psychogenic pseudosyncope (PPS) after communication of the diagnosis. METHODS: This was a retrospective cohort study of patients with PPS referred in 2007 to 2015 to a tertiary referral center for syncope. We reviewed patient records and studied attack frequency, factors affecting attack frequency, health care use, and quality of life using a questionnaire. We explored influences on attack freedom and attack frequency in the 6 months before follow-up for age, sex, education level, duration until diagnosis, probability of diagnosis, additional syncope, and acceptance of diagnosis. RESULTS: Forty-seven of 57 patients with PPS could be traced, of whom 35 (74%) participated. Twelve (34%) were attack-free for at least 6 months. The median time from diagnosis to follow-up was 50 months (range 6-103 months). Communicating and explaining the diagnosis resulted in immediate reduction of attack frequency (p = 0.007) from the month before diagnosis (median one attack, range 0-156) to the month after (median one attack, range 0-16). In the 6 months before follow-up, the number of admissions decreased from 19 of 35 to 0 of 35 (p = 0.002). The use of somatic and mental health care shifted toward the latter (p < 0.0001). Quality of life at follow-up (Short Form Health Survey 36) showed lower scores for 7 of 8 domains compared to matched Dutch control values; quality of life was not influenced by attack freedom. CONCLUSIONS: After communication of the diagnosis in PPS, attack frequency decreased and health care use shifted toward mental care. Low quality of life underlines that PPS is a serious condition.", "author" : [ { "dropping-particle" : "", "family" : "Saal", "given" : "Dirk P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Overdijk", "given" : "M Jolein", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vliet", "given" : "Irene M", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "J Gert", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurology", "id" : "ITEM-1", "issue" : "21", "issued" : { "date-parts" : [ [ "2016", "11", "22" ] ] }, "page" : "2214-2219", "publisher" : "Lippincott Williams & Wilkins", "title" : "Long-term follow-up of psychogenic pseudosyncope.", "type" : "article-journal", "volume" : "87" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.yebeh.2016.06.027", "ISBN" : "1531-8249", "ISSN" : "15255069", "PMID" : "27486953", "abstract" : "We sought to characterize the clinical features of tilt-induced psychogenic nonsyncopal collapse (PNSC) from a cohort of young patients and to compare the semiologies between PNSC and EEG-confirmed psychogenic nonepileptic seizures (PNES). A PNSC diagnosis was made if a clinical event occurred during tilt-table testing that the patient regarded as fainting, but neither hypotension nor EEG changes were present. A diagnosis of PNSC was made in 17.6% of all patients referred during the 15-month study period. Cohorts with psychogenic nonsyncopal collapse (n = 40) and PNES (n = 40) did not differ in age (15.5 \u00b1 2.2 versus 14.6 \u00b1 2.7, p = .11) or female gender (80% versus 72.5%, p = .43). Psychogenic nonsyncopal collapse events were briefer than PNES events (median: 45 versus 201.5 s, p < .001). Negative motor signs (head drop, body limpness) predominated in PNSC (85% versus 20%, p < .001), while the positive motor signs of convulsion occurred more often with PNES (90% versus 30%, p < .001). Behavioral arrest (25% versus 32.5%, p = .46) and eye closure (85% versus 72.5%, p = .21) did not differ between PNSC and PNES. Patients with PNSC were more likely to be tearful before (30% versus 7.5%, p = .02) and after (62.5% versus 7.5%, p < .001) an event. In conclusion, although overlap exists, the features of PNSC generally appear similar to neurally mediated syncope, while the features of PNES generally appear similar to epileptic seizures. Psychogenic nonsyncopal collapse and PNES likely represent similar disorders that differ primarily by clinical semiologies and referral patterns.", "author" : [ { "dropping-particle" : "", "family" : "Heyer", "given" : "Geoffrey L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albert", "given" : "Dara V.F.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weber", "given" : "Amanda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gedela", "given" : "Satyanarayana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vidaurre", "given" : "Jorge", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsy and Behavior", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "171-175", "title" : "Comparison of semiologies between tilt-induced psychogenic nonsyncopal collapse and psychogenic nonepileptic seizures", "type" : "article-journal", "volume" : "62" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.cpr.2016.06.003", "ISBN" : "0272-7358", "ISSN" : "18737811", "PMID" : "27340856", "abstract" : "Psychogenic Nonepileptic Seizures (PNES) superficially resemble epileptic seizures but are thought to have a psychological rather than epileptic basis. Patients with PNES vary widely in terms of background, personality profiles, comorbidities, response to treatment and outcomes. Previous accounts interpreting these seizures as the activation of dissociated material, a physical manifestation of emotional distress, hard-wired reflex responses, or learned behaviours cannot explain key features of the phenomenon. Drawing on a brief reviewof the literature on etiology, correlates and phenomenology of PNES, this paper integrates existing approaches and data within a novel explanatory framework that applies to all PNES patients with subjectively involuntary seizures. Following the Integrative Cognitive Model of medically unexplained symptoms, we suggest that the central feature of all PNES is the automatic activation of a mental representation of seizures (the \"seizure scaffold\") in the context of a high level inhibitory processing dysfunction. This often arises in response to elevated autonomic arousal, and may disrupt the individual's awareness of distressing material, but can become divorced from abnormal autonomic and emotional activity. This model accounts both for existing findings and the heterogeneity of patients with PNES, whilst leading to a number of novel hypotheses against which it can be evaluated.", "author" : [ { "dropping-particle" : "", "family" : "Brown", "given" : "Richard J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reuber", "given" : "Markus", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Psychology Review", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "55-70", "title" : "Towards an integrative theory of psychogenic non-epileptic seizures (PNES)", "type" : "article", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[36,37,46]", "plainTextFormattedCitation" : "[36,37,46]", "previouslyFormattedCitation" : "[36,37,46]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[36,37,46]. We have found some features in our case series to support a hypothesis that cryptogenic drop attacks may, in many cases, be a functional rather than defined pathophysiological disorder of the nervous system, on a spectrum of transient dissociation which includes psychogenic pseudosyncope and dissociative (non-epileptic) seizures (Table 2, Table 3, Figure 1, also Key Clinical Points). Features of cryptogenic drop attacks supporting this hypothesis include: 1) cryptogenic drop attacks are inconsistent with most types of falls in adults in which the fall is usually recalled ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1471-2458-5-86", "ISBN" : "1471-2458 (Electronic)\\r1471-2458 (Linking)", "ISSN" : "1471-2458", "PMID" : "16109159", "abstract" : "BACKGROUND: Falls in older people have been characterized extensively in the literature, however little has been reported regarding falls in middle-aged and younger adults. The objective of this paper is to describe the perceived cause, environmental influences and resultant injuries of falls in 1497 young (20-45 years), middle-aged (46-65 years) and older (> 65 years) men and women from the Baltimore Longitudinal Study on Aging.\\n\\nMETHODS: A descriptive study where participants completed a fall history questionnaire describing the circumstances surrounding falls in the previous two years.\\n\\nRESULTS: The reporting of falls increased with age from 18% in young, to 21% in middle-aged and 35% in older adults, with higher rates in women than men. Ambulation was cited as the cause of the fall most frequently in all gender and age groups. Our population reported a higher percentage of injuries (70.5%) than previous studies. The young group reported injuries most frequently to wrist/hand, knees and ankles; the middle-aged to their knees and the older group to their head and knees. Women reported a higher percentage of injuries in all age groups.\\n\\nCONCLUSION: This is the first study to compare falls in young, middle and older aged men and women. Significant differences were found between the three age groups with respect to number of falls, activities engaged in prior to falling, perceived causes of the fall and where they fell.", "author" : [ { "dropping-particle" : "", "family" : "Talbot", "given" : "Laura A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Musiol", "given" : "Robin J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Witham", "given" : "Erica K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Metter", "given" : "E Jeffery", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC public health", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "86", "title" : "Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury.", "type" : "article-journal", "volume" : "5" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[47]", "plainTextFormattedCitation" : "[47]", "previouslyFormattedCitation" : "[47]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[47], 2) a period of loss of awareness too short to represent syncope and only compatible with dissociation, 3) Brief dissociative symptoms just before or after the event in 43%, 4) the co-occurrence of clear dissociative (non-epileptic) seizures either before or after drop attack (28%) or functional limb weakness (31%); 5) Attack clustering and situational attacks in 35%; 6) high comorbidity of fatigue, pain and other symptoms seen in functional neurological disorders such as dissociative (non-epileptic) seizuresADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/jnnp.2010.231886", "ISBN" : "1468-330X (Electronic)\\r0022-3050 (Linking)", "ISSN" : "0022-3050", "PMID" : "21421771", "abstract" : "BACKGROUND: In clinical practice, it is sometimes observed that patients in whom psychogenic non-epileptic seizures (PNES) cease, develop another medically unexplained symptom (MUS). METHODS: In order to determine how many patients develop new MUS post diagnosis and whether patients whose attacks cease are more likely to do so, new MUS were recorded 6-12 months after the diagnosis of PNES in 187 consecutive patients. RESULTS: Compared with baseline, the overall proportion of patients with MUS increased slightly, from 70.1% to 76.5%, with 44/187 patients (23.5%) developing new MUS. There were no significant differences between attack free and non-attack free patients. Binary logistic regression analysis showed that predictors of new MUS diverged between attack free and non-attack free patients. Among patients continuing to have attacks, those with previous health related psychological trauma were 18.00 times more likely to develop new MUS (p<0.0005). In patients who became attack free, patients drawing disability benefits were 5.04 times more likely to have new MUS (p = 0.011). CONCLUSIONS: The results suggest that almost 25% of patients develop new MUS following a diagnosis of PNES, although most of those have MUS pre-diagnosis. Patients with a history of health related psychological trauma whose attacks continue after diagnosis are at particularly high risk of developing new MUS. The data do not support the hypothesis that PNES that resolve are likely to be 'replaced' by other MUS.", "author" : [ { "dropping-particle" : "", "family" : "McKenzie", "given" : "Paul S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oto", "given" : "Maria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Graham", "given" : "Christopher D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Duncan", "given" : "Roderick", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of neurology, neurosurgery, and psychiatry", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "967-969", "title" : "Do patients whose psychogenic non-epileptic seizures resolve, 'replace' them with other medically unexplained symptoms? Medically unexplained symptoms arising after a diagnosis of psychogenic non-epileptic seizures", "type" : "article-journal", "volume" : "82" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[48]", "plainTextFormattedCitation" : "[48]", "previouslyFormattedCitation" : "[48]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[48], 7) Successful treatment in some patients based on distraction techniques during the prodrome (12%).Specifically, we propose that in some individuals with cryptogenic drop attacks, the disorder is best considered a form of brief dissociative attack which then becomes established as a patterned and conditioned response generated by a fear of falling, either with or without situational triggers (Table 2 and Figure 1). We hypothesise that patients with a biological or biopsychosocial vulnerability to drop attacks typically have a triggering event such a simple fall, trip, syncope or episode of dissociation. Excessive worry about further falls, particular in inopportune settings, leads to a cognitive representation of the attacks which drives abnormal self-directed attention and rumination about the possibility of falling. The idea of a cognitive representation can be conceived both as a consciously processed illness model and in terms of Bayesian predictive coding, an idea that has been explored in depth in more recent models of dissociative (non-epileptic) attacksADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/brain/aws129", "ISBN" : "0006-8950\\r1460-2156", "ISSN" : "00068950", "PMID" : "22641838", "abstract" : "This article provides a neurobiological account of symptoms that have been called 'hysterical', 'psychogenic' or 'medically unexplained', which we will call functional motor and sensory symptoms. We use a neurobiologically informed model of hierarchical Bayesian inference in the brain to explain functional motor and sensory symptoms in terms of perception and action arising from inference based on prior beliefs and sensory information. This explanation exploits the key balance between prior beliefs and sensory evidence that is mediated by (body focused) attention, symptom expectations, physical and emotional experiences and beliefs about illness. Crucially, this furnishes an explanation at three different levels: (i) underlying neuromodulatory (synaptic) mechanisms; (ii) cognitive and experiential processes (attention and attribution of agency); and (iii) formal computations that underlie perceptual inference (representation of uncertainty or precision). Our explanation involves primary and secondary failures of inference; the primary failure is the (autonomous) emergence of a percept or belief that is held with undue certainty (precision) following top-down attentional modulation of synaptic gain. This belief can constitute a sensory percept (or its absence) or induce movement (or its absence). The secondary failure of inference is when the ensuing percept (and any somatosensory consequences) is falsely inferred to be a symptom to explain why its content was not predicted by the source of attentional modulation. This account accommodates several fundamental observations about functional motor and sensory symptoms, including: (i) their induction and maintenance by attention; (ii) their modification by expectation, prior experience and cultural beliefs and (iii) their involuntary and symptomatic nature", "author" : [ { "dropping-particle" : "", "family" : "Edwards", "given" : "Mark J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Adams", "given" : "Rick a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "Harriet", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pare\u00e9s", "given" : "Isabel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Friston", "given" : "Karl J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parees", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Friston", "given" : "Karl J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Brain", "id" : "ITEM-1", "issue" : "1460-2156 (Electronic)", "issued" : { "date-parts" : [ [ "2012", "11", "28" ] ] }, "language" : "ENG PT - JOURNAL ARTICLE", "note" : "From Duplicate 1 (A Bayesian account of 'hysteria' - Edwards, M J; Adams, R A; Brown, H; Parees, I; Friston, K J)\n\nDA - 20120529\n\nFrom Duplicate 2 (A Bayesian account of 'hysteria' - Edwards, M J; Adams, R A; Brown, H; Parees, I; Friston, K J)\n\nDA - 20121121", "page" : "3495-3512", "publisher-place" : "1 Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, UK", "title" : "A Bayesian account of 'hysteria'", "type" : "article-journal", "volume" : "135" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[45]", "plainTextFormattedCitation" : "[45]", "previouslyFormattedCitation" : "[45]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[45],ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.neubiorev.2017.01.015", "ISBN" : "0149-7634", "ISSN" : "18737528", "PMID" : "28108416", "abstract" : "The relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of \u201cmedically unexplained\u201d or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.", "author" : [ { "dropping-particle" : "", "family" : "Bergh", "given" : "Omer", "non-dropping-particle" : "Van den", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Witth\u00f6ft", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Petersen", "given" : "Sibylle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "Richard J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neuroscience and Biobehavioral Reviews", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "page" : "185-203", "title" : "Symptoms and the body: Taking the inferential leap", "type" : "article", "volume" : "74" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[49]", "plainTextFormattedCitation" : "[49]", "previouslyFormattedCitation" : "[49]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[49],ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.cpr.2016.06.003", "ISBN" : "0272-7358", "ISSN" : "18737811", "PMID" : "27340856", "abstract" : "Psychogenic Nonepileptic Seizures (PNES) superficially resemble epileptic seizures but are thought to have a psychological rather than epileptic basis. Patients with PNES vary widely in terms of background, personality profiles, comorbidities, response to treatment and outcomes. Previous accounts interpreting these seizures as the activation of dissociated material, a physical manifestation of emotional distress, hard-wired reflex responses, or learned behaviours cannot explain key features of the phenomenon. Drawing on a brief reviewof the literature on etiology, correlates and phenomenology of PNES, this paper integrates existing approaches and data within a novel explanatory framework that applies to all PNES patients with subjectively involuntary seizures. Following the Integrative Cognitive Model of medically unexplained symptoms, we suggest that the central feature of all PNES is the automatic activation of a mental representation of seizures (the \"seizure scaffold\") in the context of a high level inhibitory processing dysfunction. This often arises in response to elevated autonomic arousal, and may disrupt the individual's awareness of distressing material, but can become divorced from abnormal autonomic and emotional activity. This model accounts both for existing findings and the heterogeneity of patients with PNES, whilst leading to a number of novel hypotheses against which it can be evaluated.", "author" : [ { "dropping-particle" : "", "family" : "Brown", "given" : "Richard J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reuber", "given" : "Markus", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Psychology Review", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "55-70", "title" : "Towards an integrative theory of psychogenic non-epileptic seizures (PNES)", "type" : "article", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[46]", "plainTextFormattedCitation" : "[46]", "previouslyFormattedCitation" : "[46]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[46]. Our hypothesis is that drop attacks are at one end of a spectrum of dissociative attacks that includes brief dissociative episodes with staring and “zoning out”, more prolonged motionless unresponsiveness (psychogenic pseudosyncope) and episodes with hyperkinetic movements (dissociative seizures) (Table 3).We propose that falls occur due to brief loss of awareness secondary to episodes of dissociation. We hypothesise that this becomes a classically conditioned response and patients’ falls become associated, in some cases, with situational triggers and in some cases reinforced by a feeling of relief after the fall is over. Some patients’ drop attacks may develop through operant conditioning with conscious avoidance of stimuli associated with the drop attacks. This worry about falling can generalize to anxiety or agoraphobia through the process of ‘chaining’ where more background stimuli are associated with the drop attack. Neurological disease in general is a significant risk factor for functional disorder, being a potent cause of distortion of sensori-motor experience, cognition and anxietyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00415-011-6111-0", "ISBN" : "1432-1459 (Electronic)\\r0340-5354 (Linking)", "ISSN" : "03405354", "PMID" : "21674198", "abstract" : "Many patients with a diagnosis of neurological disease, such as multiple sclerosis, have symptoms or disability that is considered to be in excess of what would be expected from that disease. We aimed to describe the overall and relative frequency of symptoms 'unexplained by organic disease' in patients attending general neurology clinics with a range of neurological disease diagnoses. Newly referred outpatients attending neurology clinics in all the NHS neurological centres in Scotland, UK were recruited over a period of 15 months. The assessing neurologists recorded their initial neurological diagnoses and also the degree to which they considered the patient's symptoms to be explained by organic disease. Patients completed self report scales for both physical and psychological symptoms. The frequency of symptoms unexplained by organic disease was determined for each category of neurological disease diagnoses. 3,781 patients participated (91% of those eligible). 2,467 patients had a diagnosis of a neurological disease (excluding headache disorders). 293 patients (12%) of these patients were rated as having symptoms only \"somewhat\" or \"not at all\" explained by that disease. These patients self-reported more physical and more psychological symptoms than those with more explained symptoms. No category of neurological disease was more likely than the others to be associated with such symptoms although patients with epilepsy had fewer. A substantial proportion of new outpatients with diagnoses of neurological disease also have symptoms regarded by the assessing neurologist as being unexplained by that disease; no single neurological disease category was more likely than others to be associated with this phenomenon.", "author" : [ { "dropping-particle" : "", "family" : "Stone", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Duncan", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roberts", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Coleman", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Warlow", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murray", "given" : "G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pelosi", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cavanagh", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matthews", "given" : "K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goldbeck", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharpe", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Neurology", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2012", "6", "16" ] ] }, "language" : "ENG PT - JOURNAL ARTICLE", "note" : "From Duplicate 2 (Which neurological diseases are most likely to be associated with "symptoms unexplained by organic disease". - Stone, J; Carson, A; Duncan, R; Roberts, R; Coleman, R; Warlow, C; Murray, G; Pelosi, A; Cavanagh, J; Matthews, K; Goldbeck, R; Sharpe, M)\n\nFrom Duplicate 1 ( Which neurological diseases are most likely to be associated with "symptoms unexplained by organic disease" - Stone, J; Carson, A; Duncan, R; Roberts, R; Coleman, R; Warlow, C; Murray, G; Pelosi, A; Cavanagh, J; Matthews, K; Goldbeck, R; Sharpe, M )\n\nDA - 20110615\n\nFrom Duplicate 2 ( Which neurological diseases are most likely to be associated with "symptoms unexplained by organic disease". - Stone, J; Carson, a; Duncan, R; Roberts, R; Coleman, R; Warlow, C; Murray, G; Pelosi, a; Cavanagh, J; Matthews, K; Goldbeck, R; Sharpe, M )\n\nFrom Duplicate 3 (Which neurological diseases are most likely to be associated with "symptoms unexplained by organic disease" - Stone, J; Carson, A; Duncan, R; Roberts, R; Coleman, R; Warlow, C; Murray, G; Pelosi, A; Cavanagh, J; Matthews, K; Goldbeck, R; Sharpe, M)\n\nDA - 20110615", "page" : "33-38", "publisher-place" : "School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, Scotland, UK, Jon.Stone@ed.ac.uk", "title" : "Which neurological diseases are most likely to be associated with \"symptoms unexplained by organic disease\"", "type" : "article-journal", "volume" : "259" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "PMID" : "9738677", "abstract" : "PURPOSE: To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics. METHODS: Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report. RESULTS: Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor. CONCLUSIONS: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES", "author" : [ { "dropping-particle" : "", "family" : "Westbrook", "given" : "Lauren E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Devinsky", "given" : "Orrin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geocadin", "given" : "Romergryko", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsia", "id" : "ITEM-2", "issue" : "9", "issued" : { "date-parts" : [ [ "1998", "9" ] ] }, "language" : "eng PT - Journal Article", "note" : "From Duplicate 1 (Nonepileptic seizures after head injury - Westbrook, L E; Devinsky, O; Geocadin, R)\n\nUI - 98409057", "page" : "978-982", "publisher-place" : "Department of Neurology, New York University School of Medicine, New York, USA", "title" : "Nonepileptic seizures after head injury", "type" : "article-journal", "volume" : "39" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[50,51]", "plainTextFormattedCitation" : "[50,51]", "previouslyFormattedCitation" : "[50,51]" }, "properties" : { "noteIndex" : 11 }, "schema" : "" }[50,51]. We propose that some of the neurological comorbidities described in our series have increased the risk of functional disorder rather than offering an alternate pathophysiological explanation in our patients.Table Two: Features of cryptogenic drop attacks in keeping with a functional disorderN%FunctionalSyncopeVertigoMechanicalCryptogenic OrganicInability of patients to recall falling 7793Brief dissociative or panic symptoms just prior to or after attack3643Dissociative (non-epileptic) seizures merging to drop attacks2328First attack recalled as mechanical or simple faint2024Long duration of intermittent falls without worsening or development of other symptoms7995Co-occurrence with persistent fatigue 6173Co-occurrence with functional weakness2631Attack clustering and situational attacks in some patients (in agoraphobic situations and on stairs). 29359. Feelings of ‘relief’ once the drop attack had occurred, akin to relief seen after some patients with dissociative (non-epileptic) seizures.7810. Successful treatment of attacks using a model of distraction developed for the treatment of dissociative (non-epileptic) seizures.101211.Resolution of attacks in patients232812.Female preponderance7489=possible =likely = very likelyTable Three: The proposed spectrum of functional (dissociative) attacks or seizures?Cryptogenic Drop AttacksDissociative hypokinetic attacks (psychogenic pseudosyncope)Dissociative (non-epileptic) hyperkinetic attacksDissociative ‘absence’ attackGender distributionPredominantly femalePeak age of onsetMid 40sLate 20sADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/WNL.0b013e3182a1aa88", "ISBN" : "0028-3878", "ISSN" : "00283878", "PMID" : "23873974", "abstract" : "OBJECTIVES: To provide a detailed semiology to aid the clinical recognition of psychogenic pseudosyncope (PPS), which concerns episodes of apparent transient loss of consciousness (TLOC) that mimic syncope. METHODS: We analyzed all consecutive tilt-table tests from 2006 to 2012 showing proven PPS, i.e., apparent TLOC had occurred without EEG changes or a decrease in heart rate (HR) or blood pressure (BP). We analyzed baseline characteristics, video data, EEG, ECG, and continuous BP measurements on a 1-second time scale. Data were compared with those of 69 cases of tilt-induced vasovagal syncope (VVS). RESULTS: Of 800 tilt-table tests, 43 (5.4%) resulted in PPS. The majority (74%) were women. The median duration of apparent TLOC was longer in PPS (44 seconds) than in VVS (20 seconds, p < 0.05). During the event, the eyes were closed in 97% in PPS but in only 7% in VVS (p < 0.0001). A sudden head drop or moving down the tilt table was more common in PPS than in VVS (p < 0.01), but jerking movements occurred more frequently in VVS (p < 0.0001). In PPS, both HR and BP increased before and during apparent TLOC (p < 0.0001). CONCLUSIONS: PPS is clinically distinct from VVS and can be diagnosed accurately with tilt-table testing and simultaneous EEG monitoring. Compared with VVS, eye closure during the event, long periods of apparent TLOC, and high HR and BP are highly specific for PPS. Improved understanding of the semiology of PPS as a clinical entity is vital to ensure accurate diagnosis.", "author" : [ { "dropping-particle" : "", "family" : "Tannemaat", "given" : "Martijn R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Niekerk", "given" : "Julius", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reijntjes", "given" : "Robert H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sutton", "given" : "Richard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "J. Gert", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurology", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "752-758", "title" : "The semiology of tilt-induced psychogenic pseudosyncope", "type" : "article-journal", "volume" : "81" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.yebeh.2016.06.027", "ISBN" : "1531-8249", "ISSN" : "15255069", "PMID" : "27486953", "abstract" : "We sought to characterize the clinical features of tilt-induced psychogenic nonsyncopal collapse (PNSC) from a cohort of young patients and to compare the semiologies between PNSC and EEG-confirmed psychogenic nonepileptic seizures (PNES). A PNSC diagnosis was made if a clinical event occurred during tilt-table testing that the patient regarded as fainting, but neither hypotension nor EEG changes were present. A diagnosis of PNSC was made in 17.6% of all patients referred during the 15-month study period. Cohorts with psychogenic nonsyncopal collapse (n = 40) and PNES (n = 40) did not differ in age (15.5 \u00b1 2.2 versus 14.6 \u00b1 2.7, p = .11) or female gender (80% versus 72.5%, p = .43). Psychogenic nonsyncopal collapse events were briefer than PNES events (median: 45 versus 201.5 s, p < .001). Negative motor signs (head drop, body limpness) predominated in PNSC (85% versus 20%, p < .001), while the positive motor signs of convulsion occurred more often with PNES (90% versus 30%, p < .001). Behavioral arrest (25% versus 32.5%, p = .46) and eye closure (85% versus 72.5%, p = .21) did not differ between PNSC and PNES. Patients with PNSC were more likely to be tearful before (30% versus 7.5%, p = .02) and after (62.5% versus 7.5%, p < .001) an event. In conclusion, although overlap exists, the features of PNSC generally appear similar to neurally mediated syncope, while the features of PNES generally appear similar to epileptic seizures. Psychogenic nonsyncopal collapse and PNES likely represent similar disorders that differ primarily by clinical semiologies and referral patterns.", "author" : [ { "dropping-particle" : "", "family" : "Heyer", "given" : "Geoffrey L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albert", "given" : "Dara V.F.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weber", "given" : "Amanda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gedela", "given" : "Satyanarayana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vidaurre", "given" : "Jorge", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsy and Behavior", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "171-175", "title" : "Comparison of semiologies between tilt-induced psychogenic nonsyncopal collapse and psychogenic nonepileptic seizures", "type" : "article-journal", "volume" : "62" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[37,40]", "plainTextFormattedCitation" : "[37,40]", "previouslyFormattedCitation" : "[37,40]" }, "properties" : { "noteIndex" : 4 }, "schema" : "" }[37,40]Usually presents toCardiology, NeurologyCardiologyNeurologyNeurology/PsychiatryUsual Clinical setting and ProdromePatients describe finding themselves suddenly on the ground without apparent loss of consciousnessLong duration episodes of ‘fall down lie still’ (i.e.> two minutes), typically with eyes closed ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1212/WNL.0b013e3182a1aa88", "ISBN" : "0028-3878", "ISSN" : "00283878", "PMID" : "23873974", "abstract" : "OBJECTIVES: To provide a detailed semiology to aid the clinical recognition of psychogenic pseudosyncope (PPS), which concerns episodes of apparent transient loss of consciousness (TLOC) that mimic syncope. METHODS: We analyzed all consecutive tilt-table tests from 2006 to 2012 showing proven PPS, i.e., apparent TLOC had occurred without EEG changes or a decrease in heart rate (HR) or blood pressure (BP). We analyzed baseline characteristics, video data, EEG, ECG, and continuous BP measurements on a 1-second time scale. Data were compared with those of 69 cases of tilt-induced vasovagal syncope (VVS). RESULTS: Of 800 tilt-table tests, 43 (5.4%) resulted in PPS. The majority (74%) were women. The median duration of apparent TLOC was longer in PPS (44 seconds) than in VVS (20 seconds, p < 0.05). During the event, the eyes were closed in 97% in PPS but in only 7% in VVS (p < 0.0001). A sudden head drop or moving down the tilt table was more common in PPS than in VVS (p < 0.01), but jerking movements occurred more frequently in VVS (p < 0.0001). In PPS, both HR and BP increased before and during apparent TLOC (p < 0.0001). CONCLUSIONS: PPS is clinically distinct from VVS and can be diagnosed accurately with tilt-table testing and simultaneous EEG monitoring. Compared with VVS, eye closure during the event, long periods of apparent TLOC, and high HR and BP are highly specific for PPS. Improved understanding of the semiology of PPS as a clinical entity is vital to ensure accurate diagnosis.", "author" : [ { "dropping-particle" : "", "family" : "Tannemaat", "given" : "Martijn R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Niekerk", "given" : "Julius", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reijntjes", "given" : "Robert H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sutton", "given" : "Richard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dijk", "given" : "J. Gert", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurology", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "752-758", "title" : "The semiology of tilt-induced psychogenic pseudosyncope", "type" : "article-journal", "volume" : "81" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[40]", "plainTextFormattedCitation" : "[40]", "previouslyFormattedCitation" : "[40]" }, "properties" : { "noteIndex" : 3 }, "schema" : "" }[40]Episodes of generalized or focal limb shaking, typically with eyes closed and other positive featuresADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s11910-012-0278-3", "ISBN" : "1534-6293 (Electronic)\\r1528-4042 (Linking)", "ISSN" : "15284042", "PMID" : "22576731", "abstract" : "Psychogenic nonepileptic seizures (PNES) pose clinical challenges in terms of diagnosis and management. Recent studies have thrown further light on the extent to which features of PNES semiology may distinguish PNES patients from those with epilepsy. Management of this patient group will include discussion of the diagnosis, withdrawal of antiepileptic drugs, and psychological intervention when PNES persist. However, the evidence base for these different stages remains limited, although recent studies are beginning to provide guidance for clinicians and future research.", "author" : [ { "dropping-particle" : "", "family" : "Goldstein", "given" : "Laura H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mellers", "given" : "John D C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Current Neurology and Neuroscience Reports", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "436-444", "title" : "Recent developments in our understanding of the semiology and treatment of psychogenic nonepileptic seizures", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[15]", "plainTextFormattedCitation" : "[15]", "previouslyFormattedCitation" : "[15]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[15]Episodes of being relatively unresponsive or staring, with or without experience of unawareness or dissociationProdrome and proposed MechanismProdromal dissociative symptoms and arousal in many patientsFearful anticipation increases likelihood of events and attacks may cluster situationally in someTriggerAll may apparently be triggered by initial fall, vasovagal syncope or panic attacks which are different from subsequent drop attacksADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.yebeh.2007.11.006", "ISSN" : "15255050", "PMID" : "18164250", "abstract" : "Psychogenic nonepileptic seizures (PNES) superficially resemble epileptic seizures, but are not associated with ictal electrical discharges in the brain. PNES constitute one of the most important differential diagnoses of epilepsy. However, despite the fact they have been recognized as a distinctive clinical phenomenon for centuries and that access to video/EEG monitoring has allowed clinicians to make near-certain diagnoses for several decades, our understanding of the etiology, underlying mental processes, and, subsequently, subdifferentiation, nosology, and treatment remains seriously deficient. Emphasizing the clinical picture throughout, the first part of this article is intended to \"look and look again\" at what we know about the epidemiology, semiology, clinical context, treatment, and prognosis of PNES. The second part is dedicated to the questions that remain to be answered. It argues that the most important reason our understanding of PNES remains limited is the focus on the visible manifestations of PNES or the seizures themselves. In contrast, subjective seizure manifestations and the biographic or clinical context in which they occur have been relatively neglected", "author" : [ { "dropping-particle" : "", "family" : "Reuber", "given" : "Markus", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsy and Behavior", "id" : "ITEM-1", "issue" : "1525-5050 (Print)", "issued" : { "date-parts" : [ [ "2008", "5" ] ] }, "language" : "eng PT - Journal Article PT - Review SB - IM", "note" : "From Duplicate 2 (Psychogenic nonepileptic seizures: answers and questions - Reuber, M)\n\nDA - 20080324", "page" : "622-635", "publisher-place" : "Academic Neurology Unit, University of Sheffield/Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK. mreuber@.uk", "title" : "Psychogenic nonepileptic seizures: Answers and questions", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "PMID" : "9738677", "abstract" : "PURPOSE: To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics. METHODS: Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report. RESULTS: Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor. CONCLUSIONS: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES", "author" : [ { "dropping-particle" : "", "family" : "Westbrook", "given" : "Lauren E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Devinsky", "given" : "Orrin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geocadin", "given" : "Romergryko", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsia", "id" : "ITEM-2", "issue" : "9", "issued" : { "date-parts" : [ [ "1998", "9" ] ] }, "language" : "eng PT - Journal Article", "note" : "From Duplicate 1 (Nonepileptic seizures after head injury - Westbrook, L E; Devinsky, O; Geocadin, R)\n\nUI - 98409057", "page" : "978-982", "publisher-place" : "Department of Neurology, New York University School of Medicine, New York, USA", "title" : "Nonepileptic seizures after head injury", "type" : "article-journal", "volume" : "39" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[16,51]", "plainTextFormattedCitation" : "[16,51]", "previouslyFormattedCitation" : "[16,51]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[16,51]In our series, recurrent facial soft tissue injuries were more common than the bruised knees from which drop attacks gain their French name ‘la maladie des genoux bleus’. Injuries have long been associated with dissociative seizures occurring in 30-40% of case series ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.seizure.2014.02.001", "ISSN" : "15322688", "PMID" : "24602798", "abstract" : "Purpose Whilst ictal injuries in psychogenic non-epileptic seizures (PNES) have been reported previously, very few studies have described the spectrum of ictal injuries in these patients. In the current study, we tried to determine the spectrum of reported ictal injuries associated with PNES and to investigate the possible associated risk factors. Methods All patients with PNES were recruited prospectively in the outpatient epilepsy clinic at Shiraz University of Medical Sciences, between 2008 and 2013. The diagnosis was made by clinical assessment and ictal video-EEG recordings. We asked all patients and their caregivers about history of any minor (e.g., tongue biting, bruises, and lacerations) or major (e.g., burns and fractures) physical injuries associated with their seizures, since their disease started. Clinical variables, factors potentially predisposing to PNES and video-EEG recordings of all patients were analyzed. Results Two hundred and eleven patients were studied. Sixty-five patients (30.8%) reported injuries with one or more of their attacks. The most common type of reported injury was tongue biting. Lacerations, bruises, limb fractures, dental injury, and burn were also reported. Conclusion PNES commonly produce physical injuries. Despite the shibboleth that injuries rarely occur during PNES, mild injuries commonly happen and even severe injuries such as fractures and burns are not uncommonly reported in these patients. Patients with more dramatic seizure manifestations (e.g., urinary incontinence) were more likely to report ictal injuries. ?? 2014 British Epilepsy Association.", "author" : [ { "dropping-particle" : "", "family" : "Asadi-Pooya", "given" : "Ali a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Emami", "given" : "Mehrdad", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Emami", "given" : "Yasaman", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Seizure", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "363-366", "publisher" : "BEA Trading Ltd", "title" : "Ictal injury in psychogenic non-epileptic seizures", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "PMID" : "7555972", "abstract" : "Two patients who incurred significant injuries during psychogenic seizures prompted us to do a telephone survey of self-injury and incontinence in 102 consecutive patients diagnosed with psychogenic seizures by EEG-closed-circuit TV (EEG-CCTV) monitoring. Seventy-three patients (or a close family member or friend) were reached by telephone and responded to our survey. During typical attacks of psychogenic seizures, 40% reported injuries, 44% reporting tongue biting, and 44% reported urinary incontinence. Suicide attempts were reported by 32% and were more common in those with self-injury and urinary incontinence. We compared the results of patients with psychogenic seizures with those of 30 patients with refractory epilepsy documented by ictal recordings, using a similar telephone survey. Injuries of all types were more commonly reported by epilepsy patients. Burn injuries were reported only by patients with epilepsy. Suicide attempts were more commonly reported by the psychogenic seizure group. Self-injury and incontinence are commonly reported by psychogenic seizure patients. In view of their significant association with suicide attempts, they may indicate an underlying depression", "author" : [ { "dropping-particle" : "", "family" : "Peguero", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "bou-Khalil", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fakhoury", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mathews", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsia", "id" : "ITEM-2", "issue" : "0013-9580 (Print)", "issued" : { "date-parts" : [ [ "1995", "6" ] ] }, "language" : "eng PT - Case Reports PT - Journal Article SB - IM", "note" : "DA - 19951106", "page" : "586-591", "publisher-place" : "Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennesse, USA", "title" : "Self-injury and incontinence in psychogenic seizures", "type" : "article-journal", "volume" : "36" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[52,53]", "plainTextFormattedCitation" : "[52,53]", "previouslyFormattedCitation" : "[52,53]" }, "properties" : { "noteIndex" : 11 }, "schema" : "" }[52,53]. Drop attacks are not a benign condition either and many of our patients gave up work or had substantial social and occupational impairment. Comorbid functional neurological disorders have not been previously described in patients with cryptogenic drop attacks including in Steven’s and Matthew’s paper. Given that one third of our patients were unselected referrals to a general neurology service this suggests a genuine association. The absence of comorbid functional disorders in reported literature may be due to lack of expertise in identifying functional disorders by non-neurologists seeing these patients or lack of confidence in making a diagnosis by neurologists. Similar underreporting of psychogenic pseudosyncope is seen in large cohort studies of syncope ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.5603/CJ.a2014.0070", "author" : [ { "dropping-particle" : "", "family" : "Tannemaat", "given" : "Authors Martijn R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "Van", "family" : "Dijk", "given" : "J Gert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "cardiology journal", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "658-64", "title" : "Managing psychogenic pseudosyncope : Facts and experiences", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[54]", "plainTextFormattedCitation" : "[54]", "previouslyFormattedCitation" : "[54]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[54]. The lack of any in-depth studies of younger patients with cryptogenic drop attacks since 1973 may also play a role. Even if the majority of patients with cryptogenic drop attacks can be thought of as attacks within the spectrum a functional neurological disorder, there are patients in our study in whom the aetiology of their drop attacks remains cryptogenic. Men were entirely absent from the Stevens and Matthews series. They represented 11% of our cohort and are under-represented even in older drop attack populations ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1760-1703", "PMID" : "16044488", "author" : [ { "dropping-particle" : "", "family" : "Parry", "given" : "Steve W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kenny", "given" : "Rose Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Psychologie & neuropsychiatrie du vieillissement", "id" : "ITEM-1", "issue" : "I", "issued" : { "date-parts" : [ [ "2005", "6" ] ] }, "page" : "137-138", "title" : "Drop attacks in older adults: systematic assessment has a high diagnostic yield", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[5]", "plainTextFormattedCitation" : "[5]", "previouslyFormattedCitation" : "[5]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[5]. In our study the comorbid defined pathophysiological risk factors at baseline or follow up was over three times that in men than women (55% vs. 15%), raising the possibility that mechanisms of drop attacks in men may have some differences to women. The absence of a comorbid functional disorder should also signal a warning flag for underlying pathophysiological disorders given the high proportion (50%) in our eight patients.We acknowledge significant limitations in this data which we present as hypothesis generating. This was a retrospective study of consecutive cases seen in routine clinical care and clinical variables were chosen from this material. There?are many variables, including adverse childhood experience, that we did?not collect. Importantly, not all patients were subject to neuroimaging or cardiac investigation such as 24 hour ECG or EEG. More detailed investigations such as tilt table testing and specific measures of balance were not appliedADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/RHU.0b013e318190f991.Fibromyalgia", "author" : [ { "dropping-particle" : "", "family" : "Jones", "given" : "KIm", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Horak", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stone Winters", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morea", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bennett", "given" : "Robert M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Clin Rheum", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "note" : "top 10 most debilitating syx 45% -68% reported\n\nABC fear of falling \n\nslowing of walking with a secondary cognitivve task thoguht to represent increased attentional resources on balance and gait \n\nauditory brainstem responses", "page" : "16-21", "title" : "Fibromyalgia is Associated with Impaired Balance and Falls", "type" : "article-journal", "volume" : "15" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[55]", "plainTextFormattedCitation" : "[55]", "previouslyFormattedCitation" : "[55]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[55]. It remains the case, that some of these patients may have alternative diagnoses, particularly syncope. A comparison group with a paroxysmal condition such as neurocardiogenic syncope would have helped to examine the specificity of some of the proposed associations. JS’s clinical interest in functional disorders may have biased frequency of comorbidity, although similar frequencies were seen in unselected referrals to a general neurology clinic. Because our patients were seen clinically rather than in a research study, physiological and structural measures of falls, such as dynamic posturography, used in other studies were not routinely used in our patients. Sixteen of the 83 patients were referred from outside of the health board which may have led to an underestimate of follow up diagnoses. Data on treatment modalities and outcomes was insufficient for more in-depth analysis, so was only considered anecdotally.Additionally, ideas solidified through the process of seeing patients and some of the questions asked of the 83rd patient were not the same as those asked of the first. We have endeavored to make the process as uniform as possible by including only those patients who were seen by the author JS and excluding patients where the description of the attack could not be judged by the rest of the research team. We present our data to support a hypothesis weaved together from the stories of the patients seen in routine clinical practice. We suggest considering cryptogenic drop attacks in some patients as a subtype of functional neurological disorder. We propose that brief episodes of dissociation, often precipitated by a mechanical fall or faint, perpetuated by fear of falling can become habitual via a conditioned behavioral response. This could lead to specific treatment techniques involving education, distraction techniques, overcoming avoidance and graded exposure to the conditioned stimuli.A prospective multi-centre controlled study of drop attacks in younger individuals that avoids the limitation of this case series including tilt-table testing and, where possible, timing of loss of awareness as well as multiple psychological, physiological and structural measures is warranted to examine the question of whether cryptogenic drop attacks overlap with functional neurological symptom disorders or are better thought of, and treated as, functional drop attacks.FundingIH is supported by an Association of British Neurologists/Patrick Berthoud Clinical Research Training Fellowship. JS is supported by an NHS Scotland NRS Career Fellowship.Note to reviewers who may have seen the abstract for this study (not to be published) Data on investigations have been updated since an earlier version of this study-27305-419735Table One: Differential Diagnoses of Drop AttacksTable One: Differential Diagnoses of Drop Attacks?Cryptogenic Drop AttacksCardiac SyncopeCarotid sinus hypersensitivity Vestibular drop attacksPosterior circulation TIAChiari malformationsColloid cyst of the third ventricle Epileptic drop attacks (including brief focal, tonic or atonic seizures)Structural cardiac diseases (e.g. atrial myxoma)Usual DemographicsWomen,mid 40sRare in childrenOften occurs >60sADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/nrneurol.2009.99", "ISBN" : "1759-4758", "ISSN" : "1759-4758", "PMID" : "19597513", "abstract" : "Episodes of transient loss of consciousness (TLOC) events pose diagnostic difficulties, as the causes are diverse, carry vastly different risks, and span various specialties. An inconsistent terminology contributes to the confusion. Here, we present a classification scheme for TLOC, based on ongoing multidisciplinary efforts including those of the Task Force on Syncope of the European Society of Cardiology. We also discuss the pathophysiology of TLOC and the key clinical features that aid diagnosis. TLOC is defined as an apparent loss of consciousness with an abrupt onset, a short duration, and a spontaneous and complete recovery. Syncope is defined as TLOC due to cerebral hypoperfusion, and is divided into reflex syncope (synonymous with neurally mediated syncope), syncope due to orthostatic hypotension, and cardiac syncope (arrhythmic or associated with structural cardiac disease). The other major groups of TLOC are generalized epileptic seizures, functional TLOC (psychogenic TLOC mimicking either epilepsy or syncope), and a further group of miscellaneous disorders. The management of patients who experience TLOC requires the recognition of the defining features of each of the major groups, and cooperation between different clinical specialties.", "author" : [ { "dropping-particle" : "", "family" : "Dijk", "given" : "J Gert", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benditt", "given" : "David G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wieling", "given" : "Wouter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nature reviews. Neurology", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "438-448", "title" : "A guide to disorders causing transient loss of consciousness: focus on syncope.", "type" : "article-journal", "volume" : "5" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[38]", "plainTextFormattedCitation" : "[38]", "previouslyFormattedCitation" : "[38]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[38]M:F ratio 4:1>50yrsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/l.2012.10.002", "ISSN" : "1558-2264", "PMID" : "23217692", "abstract" : "Carotid sinus hypersensitivity was first reported more than 200 years ago. Nevertheless, a complete understanding of this relatively common clinical finding in older patients has proven elusive. There is evidence to support an association between symptoms, particularly syncope, and a hypersensitive response to carotid sinus massage. However, the clinical implication of a high prevalence in asymptomatic healthy older persons is not known. A central degenerative process likely underlies the pathophysiology, but this is as yet unproven. Although selected patients have had symptom improvement with treatment, particularly permanent pacing, there is a dearth of randomized controlled trial data to guide management.", "author" : [ { "dropping-particle" : "", "family" : "Seifer", "given" : "Colette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiology clinics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "2" ] ] }, "page" : "111-21", "title" : "Carotid sinus syndrome.", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[17]", "plainTextFormattedCitation" : "[17]", "previouslyFormattedCitation" : "[17]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[17]?F:M ratio 1-3:1ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Meniere\u2019s disease is a chronic illness that aff ects a substantial number of patients every year worldwide. The disease is characterised by intermittent episodes of vertigo lasting from minutes to hours, with fl uctuating sensorineural hearing loss, tinnitus, and aural pressure. Although there is currently no cure, more than 85% of patients with Meniere\u2019s disease are helped by either changes in lifestyle and medical treatment, or minimally invasive surgical procedures such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. Vestibular neurectomy has a very high rate of vertigo control and is available for patients with good hearing who have failed all other treatments. Labyrinthectomy is undertaken as a last resort and is best reserved for patients with unilateral disease and deafness. Introduction", "author" : [ { "dropping-particle" : "", "family" : "Hain", "given" : "Timothy C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "406-14", "title" : "Meniere \u2019 s Disease", "type" : "article-journal", "volume" : "372" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[18]", "plainTextFormattedCitation" : "[18]", "previouslyFormattedCitation" : "[18]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[18]40-60yrsM>F; >65yrsF:M ratio 1.3-1.7:1?ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00013414-200109000-00005", "ISSN" : "1050-6438", "author" : [ { "dropping-particle" : "", "family" : "Meadows", "given" : "Jeffery", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guarnieri", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Miller", "given" : "Ken", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Haroun", "given" : "Raymond", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kraut", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "Benjamin S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurosurgery Quarterly", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2001", "9" ] ] }, "page" : "220-229", "title" : "Type I Chiari Malformation: A Review of the Literature", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[19]", "plainTextFormattedCitation" : "[19]", "previouslyFormattedCitation" : "[19]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[19]30-35yrsM:F ratio 1.5:1,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0090-3019", "PMID" : "12128295", "abstract" : "BACKGROUND: Colloid cyst of the third ventricle is a relatively rare intracranial tumor. It generates tremendous interest for the neurosurgeon because of its benign nature, deep location, and an excellent prognosis when diagnosed early and excised.\n\nMETHOD: A retrospective analysis of 105 cases of third ventricle colloid cyst treated between 1967 to 1998 was conducted. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. The transcallosal and transcortical-transventricular approaches were predominantly used. Memory and psychological assessment were carried out both pre- and postoperatively. A computerized tomography (CT) scan was performed during follow-up.\n\nRESULTS: The male to female ratio was 1.5:1. The age of the patients ranged from 10 to 68 years. Headache was the most common symptom. Papilledema and short-term memory disturbances were the most common signs. In 5 patients the colloid cyst was detected incidentally. Surgery for colloid cyst was performed in 93 patients. Transcallosal and transcortical-transventricular approaches were performed in 62 and 30 patients, respectively. In 1 patient the cyst was excised through the subfrontal lamina terminalis approach. Total excision was achieved in 90 patients, while partial cyst excision was done in three patients. Moderate to severe lateral ventricular enlargement was found in 76 patients at presentation. A ventriculoperitoneal shunt was the only surgical procedure performed in 7 patients. In 16 patients colloid cyst excision was conducted after cerebrospinal fluid (CSF) diversion via a shunt. No surgical treatment of any kind was performed in 5 patients. Five patients died. Eighty-six patients came for follow-up, with a range from 1 month to 25 years (average 3 years and 8 months). Postoperatively, transient recent memory deficits occurred in 14 patients, while a permanent recent memory loss was noted in 2 patients. There was no incidence of postoperative disconnection syndrome or behavioral disturbance. A CT scan was performed in 44 patients during follow-up. Recurrence was detected in 1 patient in whom the cyst had been partially excised.\n\nCONCLUSIONS: Colloid cyst, although a benign tumor, is surgically challenging because of its deep midline location. Early detection and total excision of the colloid cyst carries an excellent prognosis.", "author" : [ { "dropping-particle" : "", "family" : "Desai", "given" : "Ketan I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nadkarni", "given" : "Trimurti D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Muzumdar", "given" : "Dattatraya P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goel", "given" : "Atul H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgical neurology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2002", "5" ] ] }, "page" : "295-302; discussion 302-4", "title" : "Surgical management of colloid cyst of the third ventricle--a study of 105 cases.", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[20]", "plainTextFormattedCitation" : "[20]", "previouslyFormattedCitation" : "[20]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[20] 30-40yrsM:F ratio variableChildhood onsetADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.seizure.2015.08.001", "ISSN" : "15322688", "abstract" : "Purpose We set out to determine clinical and EEG features of seizures presenting with falls, epileptic drop attacks and atonia in the video EEG monitoring unit. Methods We searched the video EEG monitoring reports over a 5-year-period for the terms \"drop\", \"fall\" and \"atonic\". Results Seizures presenting as epileptic drop attacks, falls or atonia were found in 23/1112 (2%) admissions. About half of the patients suffering from these seizure types had developmental delay and learning difficulties and in half of the patients a lesion was seen on MRI which was often frontal. The presumed epileptogenic zone was frontal in many cases (43%), unclear with regards to a region or multifocal in 48% and posterior temporal/occipital in 2 patients (9%). EEG patterns recorded were paroxysmal fast activity, spike and wave discharges and EEG attenuation. Seizure related falls were seen in 8 cases (34%) with injuries recorded during Video EEG monitoring in half of those. Conclusion Clinical and EEG features outlined here can help the clinician to recognise patients at risk for these devastating seizure types.", "author" : [ { "dropping-particle" : "", "family" : "Baraldi", "given" : "Sara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Farrell", "given" : "Fiona", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benson", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diehl", "given" : "Beate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wehner", "given" : "Tim", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kovac", "given" : "Stjepana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Seizure", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "4-8", "publisher" : "BEA Trading Ltd", "title" : "Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1111/j.1528-1167.2009.02231.x", "ISSN" : "00139580", "PMID" : "19702729", "abstract" : "Tonic and atonic seizures are typically seen in what are often referred to as the catastrophic epilepsies. In simply considering what each of the terms signifies (either the complete loss of tone or a marked increase in tone), they would appear to be at the most diverse ends of the spectrum. They would appear to be as opposite as hot and cold or hard and soft. And yet they are often found to occur in the same patient. This article examines the nature of these seizures and discusses some of the syndromes in which they are seen. Although these seizures are often very difficult to control, some of our medications/therapies have been shown to be effective. Recommendations concerning the efficacy of these therapies and a review of the newer therapies are provided. In addition, the ketogenic diet has been particularly successful in treating these seizures; this is discussed in some detail. Finally, although outcomes for these children are generally less than ideal, many can be helped with a persistent approach that balances seizure control against the side effects of medication.", "author" : [ { "dropping-particle" : "", "family" : "Vining", "given" : "Eileen P G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsia", "id" : "ITEM-2", "issue" : "SUPPL. 8", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "21-24", "title" : "Tonic and atonic seizures: Medical therapy and ketogenic diet", "type" : "article-journal", "volume" : "50" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[4,21]", "plainTextFormattedCitation" : "[4,21]", "previouslyFormattedCitation" : "[4,21]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[4,21]F>M60sADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.carpath.2011.12.004", "ISBN" : "19362625", "ISSN" : "10548807", "PMID" : "22300501", "abstract" : "Background: Tumors of the heart are rare compared to other cardiac diseases. Their clinical symptoms vary from absent to nonspecific. This great variation and general paucity of symptoms related to cardiac tumors often result in delayed diagnosis and treatment. Methods: We retrospectively evaluated all patients who underwent cardiac surgery for a space-occupying lesion in the observation period between 2000 and 2010 at our hospital. Clinicopathological features, imaging characteristics, and disease outcomes were analyzed, and the results were compared with the available English literature. Results: During the last 10 years, 84 patients underwent resection of a cardiac mass at our center, i.e., 0.85% of the total number (n=9829) of all cardiac surgical operations performed in that period. The part of primary cardiac tumors was 73.8% (n=62; 59 benign and 3 malign tumors). In nine cases (10.7%), secondary cardiac tumors represented metastases of malignant tumors from different extracardiac locations. In 13 cases (15.5%), the mass represented cardiac thrombus. The majority of cardiac tumors were benign, and most of them were cardiac myxomas (n=48). Papillary fibroelastoma was the second most common primary tumor. Conclusions: Our data in this study were comparable to the literature regarding the frequency and allocation of the different cardiac tumors. Our data are in line with previous reports that patients with benign cardiac tumors profit from surgical resection compared to those subjected to conservative treatment with the risk of central or peripheral embolisms. Concerning malignant primary cardiac tumors and cardiac metastases, surgery represents only a palliative strategy in most of the cases. \u00a9 2012 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Strecker", "given" : "Thomas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "R\u00f6sch", "given" : "Johannes", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weyand", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Agaimy", "given" : "Abbas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovascular Pathology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "436-443", "publisher" : "Elsevier Inc.", "title" : "Primary and metastatic cardiac tumors: Imaging characteristics, surgical treatment, and histopathological spectrum: A 10-year-experience at a German heart center", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.carpath.2013.04.006", "ISBN" : "1054-8807", "ISSN" : "10548807", "PMID" : "23727543", "abstract" : "Introduction: Primary cardiac tumors are rare entities with an autopsy frequency ranging between 0.001% and 0.3%. Our objective was to review 32 years of experience from a Spanish tertiary surgical center. Method: We collected data on 73 patients with a histopathological diagnosis of a primary cardiac tumor in a retrospective analysis from 1979 to 2012. Tissue samples were obtained either at surgery or from necropsy and subsequently divided into benign and malignant groups. Results: Benign neoplasms accounted for 84.9% of cases. The average age at diagnosis was 61 years, and tumors were twice as frequent among women. It was an incidental finding in one quarter of patients. In symptomatic patients, the typical presentation was of cardioembolic stroke or of congestive symptoms. Myxoma (93.5%) was the most common diagnosis, typically affecting the left atrium (74.2%). Surgical resection was curative for 95% of these patients. Malignant tumors represented 15.1% of cases with an average age at diagnosis of 50 years. Over 90% of these patients were symptomatic at presentation with the cardinal symptom being heart failure. Undifferentiated sarcoma was the most frequent malignant tumor (36.4%). Less than 20% of patients were alive 1 year after diagnosis despite the treatment. Conclusions: In our study, primary cardiac tumors were insidious. The most common was left atrial myxoma in which surgical resection was considered curative. Undifferentiated sarcoma was the most frequent malignant tumor. Malignant neoplasms carried a worse prognosis with unsuccessful total excision and the presence of metastatic disease being markers of an adverse outcome. ?? 2013 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Barreiro", "given" : "Manuel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Renilla", "given" : "Alfredo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jimenez", "given" : "Jaime M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Mar??a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Musa", "given" : "Tarique", "non-dropping-particle" : "Al", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garcia", "given" : "Laura", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barriales", "given" : "Vicente", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovascular Pathology", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "424-427", "publisher" : "Elsevier Inc.", "title" : "Primary cardiac tumors: 32 Years of experience from a Spanish tertiary surgical center", "type" : "article-journal", "volume" : "22" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[22,23]", "plainTextFormattedCitation" : "[22,23]", "previouslyFormattedCitation" : "[22,23]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[22,23]FrequencyUnclearEstimated at 3.5-9% of all falls referralsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.1.5851.439", "ISSN" : "0959-8138", "PMID" : "4689829", "abstract" : "A drop attack was defined as falling without warning, not apparently due to any malfunction of the legs, not induced by change of posture or movement of the head, and not accompanied by vertigo or other cephalic sensation. All 33 patients attending a neurological clinic with a primary complaint fulfilling these criteria were women, and a further seven examples were found by questioning 200 consecutive patients at a gynaecological clinic. No affected male was found.In all but one patient, falls occurred only when walking. They were not due to wearing high-heeled shoes. The average age at onset was 44.5 years and in younger women onset was often during pregnancy. The accepted causes of drop attacks were not found with certainty in any of these patients. The sex incidence and the circumstances of the falls suggest that the cause may lie in differences between the two sexes in the mechanism of walking rather than in any central disturbance. Drop attacks in women commonly occur as an isolated symptom for many years, and although distressing have no serious prognostic implications.", "author" : [ { "dropping-particle" : "", "family" : "Stevens", "given" : "D L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matthews", "given" : "W B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British medical journal", "id" : "ITEM-1", "issue" : "February", "issued" : { "date-parts" : [ [ "1973", "2", "24" ] ] }, "page" : "439-42", "title" : "Cryptogenic drop attacks: an affliction of women.", "type" : "article-journal", "volume" : "1" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/S0749-0690(02)00002-2", "ISBN" : "0749-0690 (Print)\\r0749-0690 (Linking)", "ISSN" : "07490690", "PMID" : "12180240", "abstract" : "Falls, syncope, and the associated complications are among the most serious problems that face the elderly population. The most common underlying causes and risk factors for falls include muscle weakness, gait and balance problems, visual impairment, cognitive impairment, depression, functional decline, and particular medications (especially in the presence of environmental hazards). Studies have identified the relative risks for these factors that enable a fairly accurate prediction of who is at high risk for falls and what areas to target for falls-prevention activity. Causes and risk factors for syncope have not been studied as well in the older population. The most serious types of syncope have underlying cardiac etiologies but they cause less than 25% of the reported cases. The largest category of syncope (approximately 40%) is syncope of unknown etiology, which defies careful diagnostic evaluation but seems to be fairly benign. The epidemiology of these syndromes can provide extremely helpful insights for developing falls-prevention strategies.", "author" : [ { "dropping-particle" : "", "family" : "Rubenstein", "given" : "Laurence Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Josephson", "given" : "Karen R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in geriatric medicine", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2002", "5" ] ] }, "note" : "Ref 91 and 99 post-fall anxiety", "page" : "141-58", "title" : "The epidemiology of falls and syncope.", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[1,35]", "plainTextFormattedCitation" : "[1,35]", "previouslyFormattedCitation" : "[1,35]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[1,35]15% of patients with syncopeADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3233/JPN-2010-0354", "ISBN" : "1528-1167", "ISSN" : "13042580", "PMID" : "23153208", "abstract" : "Clinicians who diagnose and manage epilepsy frequently encounter diagnoses of a nonneurological nature, particularly when assessing patients with transient loss of consciousness (T-LOC). Among these, and perhaps the most important, is cardiac syncope. As a group, patients with cardiac syncope have the highest likelihood of subsequent sudden death, and yet, unlike sudden unexpected death in epilepsy (SUDEP) for example, it is the norm for these tragic occurrences to be both easily predictable and preventable. In the 12 months following initial presentation with cardiac syncope, sudden death has been found to be 6 times more common than in those with noncardiac syncope (N Engl J Med 309, 1983, 197). In short, for every patient seen with T-LOC, two fundamental aims of the consultation are to assess the likelihood of cardiac syncope as the cause, and to estimate the risk of future sudden death for the individual. This article aims to outline for the noncardiologist how to recognize cardiac syncope, how to tell it apart from more benign cardiovascular forms of syncope as well as from seizures and epilepsy, and what can be done to predict and prevent sudden death in these patients. This is achieved through the assessment triad of a clinical history and examination, risk stratification, and 12-lead electrocardiography (ECG).", "author" : [ { "dropping-particle" : "", "family" : "McLeod", "given" : "Karen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Pediatric Neurology", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "59-61", "title" : "Cardiac syncope", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[24]", "plainTextFormattedCitation" : "[24]", "previouslyFormattedCitation" : "[24]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[24]10% of population >65yrs old22-68% of older patients with syncope and fallsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/l.2012.10.002", "ISSN" : "1558-2264", "PMID" : "23217692", "abstract" : "Carotid sinus hypersensitivity was first reported more than 200 years ago. Nevertheless, a complete understanding of this relatively common clinical finding in older patients has proven elusive. There is evidence to support an association between symptoms, particularly syncope, and a hypersensitive response to carotid sinus massage. However, the clinical implication of a high prevalence in asymptomatic healthy older persons is not known. A central degenerative process likely underlies the pathophysiology, but this is as yet unproven. Although selected patients have had symptom improvement with treatment, particularly permanent pacing, there is a dearth of randomized controlled trial data to guide management.", "author" : [ { "dropping-particle" : "", "family" : "Seifer", "given" : "Colette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiology clinics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "2" ] ] }, "page" : "111-21", "title" : "Carotid sinus syndrome.", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[17]", "plainTextFormattedCitation" : "[17]", "previouslyFormattedCitation" : "[17]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[17],ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1760-1703", "PMID" : "16044488", "author" : [ { "dropping-particle" : "", "family" : "Parry", "given" : "Steve W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kenny", "given" : "Rose Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Psychologie & neuropsychiatrie du vieillissement", "id" : "ITEM-1", "issue" : "I", "issued" : { "date-parts" : [ [ "2005", "6" ] ] }, "page" : "137-138", "title" : "Drop attacks in older adults: systematic assessment has a high diagnostic yield", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[5]", "plainTextFormattedCitation" : "[5]", "previouslyFormattedCitation" : "[5]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[5]190 per 100,000 of the population)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.g6544", "ISBN" : "1756-1833 (Electronic) 0959-535X (Linking)", "ISSN" : "1756-1833", "PMID" : "25391837", "author" : [ { "dropping-particle" : "", "family" : "Harcourt", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barraclough", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bronstein", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ", "id" : "ITEM-1", "issue" : "nov12 9", "issued" : { "date-parts" : [ [ "2014", "11", "12" ] ] }, "page" : "g6544-g6544", "title" : "Meniere's disease", "type" : "article-journal", "volume" : "349" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[25]", "plainTextFormattedCitation" : "[25]", "previouslyFormattedCitation" : "[25]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[25]20% of ischemic eventsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMra041544", "ISSN" : "1533-4406", "PMID" : "15972868", "author" : [ { "dropping-particle" : "", "family" : "Savitz", "given" : "Sean I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caplan", "given" : "Louis R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The New England journal of medicine", "id" : "ITEM-1", "issue" : "25", "issued" : { "date-parts" : [ [ "2005", "6", "23" ] ] }, "page" : "2618-26", "title" : "Vertebrobasilar disease.", "type" : "article-journal", "volume" : "352" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[26]", "plainTextFormattedCitation" : "[26]", "previouslyFormattedCitation" : "[26]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[26] Radiological prevalence 0.77%3% of patients present with drop attacksADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1159/000260909", "ISSN" : "1423-0305", "PMID" : "19940537", "abstract" : "BACKGROUND: Chiari I malformation (CM1) is characterized by impaired CSF flow through the foramen magnum. Dysfunctional autonomic cardiovascular regulation may result in syncope. Syncope may be the primary presenting symptom of CM1: a syndrome termed Chiari drop attack. It has been postulated that Chiari drop attack is secondary to dysautonomia caused by hindbrain compression. There has been recent debate regarding the association between CM1, dysautonomia and Chiari drop attack. METHODS: We selected patients with Chiari drop attacks who had negative workups for cardiac syncope, followed by tilt table testing and subsequent surgical decompression. We report test results and clinical outcomes following CM1 decompression. RESULTS: Ten patients met the inclusion criteria: 5 patients had positive and 5 negative tilt table tests. Following decompression, 7 had symptomatic improvement or resolution and 3 failed to improve. The sensitivity and specificity of the tilt table test for detecting clinical improvement with surgical decompression was 43 and 33%, respectively. Tilt table testing had 40% accuracy in predicting clinical response to decompression. CONCLUSIONS: In this short series, surgical decompression of CM1 has a high success rate (70%) for patients with Chiari drop attacks. Tilt table testing has poor predictive value in judging the clinical response to surgical decompression and is not a useful test to guide surgical decision- making.", "author" : [ { "dropping-particle" : "", "family" : "Straus", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Foster", "given" : "Kimberly", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zimmerman", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Frim", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Pediatric Neurosurgery", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2009", "1" ] ] }, "page" : "384-389", "title" : "Chiari Drop Attacks: Surgical Decompression and the Role of Tilt Table Testing", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[3]", "plainTextFormattedCitation" : "[3]", "previouslyFormattedCitation" : "[3]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[3]0.5-2% of intracerebral tumoursADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0090-3019", "PMID" : "12128295", "abstract" : "BACKGROUND: Colloid cyst of the third ventricle is a relatively rare intracranial tumor. It generates tremendous interest for the neurosurgeon because of its benign nature, deep location, and an excellent prognosis when diagnosed early and excised.\n\nMETHOD: A retrospective analysis of 105 cases of third ventricle colloid cyst treated between 1967 to 1998 was conducted. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. The transcallosal and transcortical-transventricular approaches were predominantly used. Memory and psychological assessment were carried out both pre- and postoperatively. A computerized tomography (CT) scan was performed during follow-up.\n\nRESULTS: The male to female ratio was 1.5:1. The age of the patients ranged from 10 to 68 years. Headache was the most common symptom. Papilledema and short-term memory disturbances were the most common signs. In 5 patients the colloid cyst was detected incidentally. Surgery for colloid cyst was performed in 93 patients. Transcallosal and transcortical-transventricular approaches were performed in 62 and 30 patients, respectively. In 1 patient the cyst was excised through the subfrontal lamina terminalis approach. Total excision was achieved in 90 patients, while partial cyst excision was done in three patients. Moderate to severe lateral ventricular enlargement was found in 76 patients at presentation. A ventriculoperitoneal shunt was the only surgical procedure performed in 7 patients. In 16 patients colloid cyst excision was conducted after cerebrospinal fluid (CSF) diversion via a shunt. No surgical treatment of any kind was performed in 5 patients. Five patients died. Eighty-six patients came for follow-up, with a range from 1 month to 25 years (average 3 years and 8 months). Postoperatively, transient recent memory deficits occurred in 14 patients, while a permanent recent memory loss was noted in 2 patients. There was no incidence of postoperative disconnection syndrome or behavioral disturbance. A CT scan was performed in 44 patients during follow-up. Recurrence was detected in 1 patient in whom the cyst had been partially excised.\n\nCONCLUSIONS: Colloid cyst, although a benign tumor, is surgically challenging because of its deep midline location. Early detection and total excision of the colloid cyst carries an excellent prognosis.", "author" : [ { "dropping-particle" : "", "family" : "Desai", "given" : "Ketan I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nadkarni", "given" : "Trimurti D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Muzumdar", "given" : "Dattatraya P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goel", "given" : "Atul H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgical neurology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2002", "5" ] ] }, "page" : "295-302; discussion 302-4", "title" : "Surgical management of colloid cyst of the third ventricle--a study of 105 cases.", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1054/jocn.2000.0800", "ISSN" : "0967-5868", "PMID" : "11437572", "abstract" : "This paper is a retrospective review of all patients treated for a colloid cyst of the third ventricle at Royal Prince Alfred Hospital over an 18-year consecutive period. Our experience is fairly typical compared with other published series. Colloid cys ts made up 1.6% of tumours treated by the neurosurgical unit. Patients presented with non-specific neurological symptoms and signs, commonly suggestive of raised intracranial pressure. Microsurgical excision was carried out via the transcallosal route in 34 cases and the transfrontal approach in four cases. There was no apparent difference in results from the different surgical approaches. In 86% of patients reviewed after more than 6 months good long term outcome was achieved. These benign tumours can be safely cured if the diagnosis is made early and the cyst removed by careful microsurgical techniques.", "author" : [ { "dropping-particle" : "", "family" : "Jeffree", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Besser", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2001", "7" ] ] }, "page" : "328-31", "title" : "Colloid cyst of the third ventricle: a clinical review of 39 cases.", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[20,27]", "plainTextFormattedCitation" : "[20,27]", "previouslyFormattedCitation" : "[20,27]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[20,27]2% of patients admitted to national VEEG unitADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.seizure.2015.08.001", "ISSN" : "15322688", "abstract" : "Purpose We set out to determine clinical and EEG features of seizures presenting with falls, epileptic drop attacks and atonia in the video EEG monitoring unit. Methods We searched the video EEG monitoring reports over a 5-year-period for the terms \"drop\", \"fall\" and \"atonic\". Results Seizures presenting as epileptic drop attacks, falls or atonia were found in 23/1112 (2%) admissions. About half of the patients suffering from these seizure types had developmental delay and learning difficulties and in half of the patients a lesion was seen on MRI which was often frontal. The presumed epileptogenic zone was frontal in many cases (43%), unclear with regards to a region or multifocal in 48% and posterior temporal/occipital in 2 patients (9%). EEG patterns recorded were paroxysmal fast activity, spike and wave discharges and EEG attenuation. Seizure related falls were seen in 8 cases (34%) with injuries recorded during Video EEG monitoring in half of those. Conclusion Clinical and EEG features outlined here can help the clinician to recognise patients at risk for these devastating seizure types.", "author" : [ { "dropping-particle" : "", "family" : "Baraldi", "given" : "Sara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Farrell", "given" : "Fiona", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benson", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diehl", "given" : "Beate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wehner", "given" : "Tim", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kovac", "given" : "Stjepana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Seizure", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "4-8", "publisher" : "BEA Trading Ltd", "title" : "Drop attacks, falls and atonic seizures in the Video-EEG monitoring unit", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[4]", "plainTextFormattedCitation" : "[4]", "previouslyFormattedCitation" : "[4]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[4]Estimated at between 0.001-0.28% of the population from autopsy studiesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ijcard.2008.11.103", "ISBN" : "0003-4932 (Print)\\r0003-4932 (Linking)", "ISSN" : "01675273", "PMID" : "19128845", "abstract" : "Primary cardiac tumors are a rare entity compared to tumors that metastasize to the heart. Patients with such tumors may be asymptomatic. Many cases are found incidentally during evaluation of an unrelated medical condition. It is important for the clinician to have a high index of suspicion when evaluating a patient presenting with signs and systemic symptoms concerning possible malignancy, plus cardiac specific symptoms or complications. These can include new onset dyspnea, congestive heart failure, arrhythmias or murmurs varying with body positions. Imaging, particularly the use of echocardiography, remains the cornerstone of diagnosis, and may be combined with new imaging modalities of cardiac CT and MRI. The aim of this paper is to describe the epidemiology and pathophysiology of the various benign and malignant primary cardiac tumors. ?? 2008 Elsevier Ireland Ltd. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Maraj", "given" : "Suraj", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pressman", "given" : "Gregg S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Figueredo", "given" : "Vincent M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Cardiology", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "152-156", "publisher" : "Elsevier Ireland Ltd", "title" : "Primary Cardiac Tumors", "type" : "article-journal", "volume" : "133" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[32]", "plainTextFormattedCitation" : "[32]", "previouslyFormattedCitation" : "[32]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[32]Usual Clinical setting and ProdromePatients describe finding themselves suddenly on the groundDissociative symptoms pre or post attackOverlap with dissociative (non-epileptic) attacksFearful anticipation increases likelihood of events and attacks cluster situationallyCan occur in any postureno prodrome or brief prodrome without autonomic symptoms (no nausea or sweating)PallorRapid recovery after loss of consciousnessOccurs on head turning, shaving, or when wearing a tight collarADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/nrneurol.2009.99", "ISBN" : "1759-4758", "ISSN" : "1759-4758", "PMID" : "19597513", "abstract" : "Episodes of transient loss of consciousness (TLOC) events pose diagnostic difficulties, as the causes are diverse, carry vastly different risks, and span various specialties. An inconsistent terminology contributes to the confusion. Here, we present a classification scheme for TLOC, based on ongoing multidisciplinary efforts including those of the Task Force on Syncope of the European Society of Cardiology. We also discuss the pathophysiology of TLOC and the key clinical features that aid diagnosis. TLOC is defined as an apparent loss of consciousness with an abrupt onset, a short duration, and a spontaneous and complete recovery. Syncope is defined as TLOC due to cerebral hypoperfusion, and is divided into reflex syncope (synonymous with neurally mediated syncope), syncope due to orthostatic hypotension, and cardiac syncope (arrhythmic or associated with structural cardiac disease). The other major groups of TLOC are generalized epileptic seizures, functional TLOC (psychogenic TLOC mimicking either epilepsy or syncope), and a further group of miscellaneous disorders. The management of patients who experience TLOC requires the recognition of the defining features of each of the major groups, and cooperation between different clinical specialties.", "author" : [ { "dropping-particle" : "", "family" : "Dijk", "given" : "J Gert", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thijs", "given" : "Roland D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benditt", "given" : "David G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wieling", "given" : "Wouter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nature reviews. Neurology", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "438-448", "title" : "A guide to disorders causing transient loss of consciousness: focus on syncope.", "type" : "article-journal", "volume" : "5" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[38]", "plainTextFormattedCitation" : "[38]", "previouslyFormattedCitation" : "[38]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[38]Syncope occurs but many patients (20-70%) have amnesia for the syncope and present with falls only ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/l.2012.10.002", "ISSN" : "1558-2264", "PMID" : "23217692", "abstract" : "Carotid sinus hypersensitivity was first reported more than 200 years ago. Nevertheless, a complete understanding of this relatively common clinical finding in older patients has proven elusive. There is evidence to support an association between symptoms, particularly syncope, and a hypersensitive response to carotid sinus massage. However, the clinical implication of a high prevalence in asymptomatic healthy older persons is not known. A central degenerative process likely underlies the pathophysiology, but this is as yet unproven. Although selected patients have had symptom improvement with treatment, particularly permanent pacing, there is a dearth of randomized controlled trial data to guide management.", "author" : [ { "dropping-particle" : "", "family" : "Seifer", "given" : "Colette", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiology clinics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "2" ] ] }, "page" : "111-21", "title" : "Carotid sinus syndrome.", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[17]", "plainTextFormattedCitation" : "[17]", "previouslyFormattedCitation" : "[17]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[17]Patients describe a feeling of being pushed to the groundORA feeling of the surroundings suddenly moving or tilting causing the fallADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1001/archneur.60.1.71", "ISBN" : "0003-9942", "ISSN" : "0003-9942", "PMID" : "12533091", "abstract" : "BACKGROUND: Tumarkin falls are sudden drop-attack falls that occur in a subset of patients with Meniere syndrome (endolymphatic hydrops), an inner ear disorder characterized by vertigo spells and hearing loss. OBJECTIVE: To describe the clinical features and quantitative audiovestibular testing results in a case series of patients with Tumarkin falls, episodic vertigo, and normal hearing. SETTING: University referral center for disorders of balance and hearing. METHODS: Case series (unselected) of all patients with Tumarkin falls and a normal audiogram at least 1 year after onset of vestibular symptoms (n = 6) from a retrospective analysis of the records of all patients with Tumarkin falls presenting to Neurotology Clinic at UCLA Medical Center, Los Angeles, Calif, from October 1, 1975, to February 1, 2001 (N = 55). Quantitative audiologic and vestibular function testing, neurologic history, and examination were performed. RESULTS: Five of 6 patients had unilateral caloric paresis, and 1 had bilateral vestibulopathy. Five of 6 had a personal and/or family history of migraine headaches meeting International Headache Society criteria. All patients had a subjective sensation of feeling pushed by an external force, and half of the patients had a subjective tilt of the environment concurrent with the fall. CONCLUSIONS: The incidence of migraine is high in this subgroup of patients with Tumarkin falls and normal hearing. The clinical description of the falls is similar to those associated with Meniere syndrome. Further studies are needed to understand the etiology of Tumarkin falls in these patients with normal hearing.", "author" : [ { "dropping-particle" : "", "family" : "Ishiyama", "given" : "Gail", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ishiyama", "given" : "Akira", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baloh", "given" : "Robert W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Archives of neurology", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2003" ] ] }, "page" : "71-75", "title" : "Drop attacks and vertigo secondary to a non-meniere otologic cause.", "type" : "article-journal", "volume" : "60" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[34]", "plainTextFormattedCitation" : "[34]", "previouslyFormattedCitation" : "[34]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[34]Patients often fall in the same direction during each fallAssociated with limb weakness, ataxia and oculomotor palsyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.emc.2012.06.004", "ISSN" : "1558-0539", "PMID" : "22974644", "abstract" : "Dizzy patients present a significant diagnostic challenge to the emergency clinician. The discrimination between peripheral and central causes is important and will inform subsequent diagnostic evaluation and treatment. Isolated vertigo can be the only initial symptom of a posterior circulation stroke. The sensation of imbalance especially raises this possibility. Research involving strokes of the posterior circulation has lagged behind that of the anterior cerebral circulation. Investigations of the last 20 years, using new technologies in brain imaging in combination with detailed clinical studies, have revolutionized our understanding of the clinical presentation, causes, treatments, and prognosis of posterior circulation ischemia.", "author" : [ { "dropping-particle" : "", "family" : "Schneider", "given" : "Jeffrey I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olshaker", "given" : "Jonathan S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Emergency medicine clinics of North America", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2012", "8" ] ] }, "page" : "681-93", "publisher" : "Elsevier Inc", "title" : "Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke.", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[33]", "plainTextFormattedCitation" : "[33]", "previouslyFormattedCitation" : "[33]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[33],ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMra041544", "ISSN" : "1533-4406", "PMID" : "15972868", "author" : [ { "dropping-particle" : "", "family" : "Savitz", "given" : "Sean I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caplan", "given" : "Louis R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The New England journal of medicine", "id" : "ITEM-1", "issue" : "25", "issued" : { "date-parts" : [ [ "2005", "6", "23" ] ] }, "page" : "2618-26", "title" : "Vertebrobasilar disease.", "type" : "article-journal", "volume" : "352" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[26]", "plainTextFormattedCitation" : "[26]", "previouslyFormattedCitation" : "[26]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[26]Usually lasts >5minutesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0749-0690(02)00002-2", "ISBN" : "0749-0690 (Print)\\r0749-0690 (Linking)", "ISSN" : "07490690", "PMID" : "12180240", "abstract" : "Falls, syncope, and the associated complications are among the most serious problems that face the elderly population. The most common underlying causes and risk factors for falls include muscle weakness, gait and balance problems, visual impairment, cognitive impairment, depression, functional decline, and particular medications (especially in the presence of environmental hazards). Studies have identified the relative risks for these factors that enable a fairly accurate prediction of who is at high risk for falls and what areas to target for falls-prevention activity. Causes and risk factors for syncope have not been studied as well in the older population. The most serious types of syncope have underlying cardiac etiologies but they cause less than 25% of the reported cases. The largest category of syncope (approximately 40%) is syncope of unknown etiology, which defies careful diagnostic evaluation but seems to be fairly benign. The epidemiology of these syndromes can provide extremely helpful insights for developing falls-prevention strategies.", "author" : [ { "dropping-particle" : "", "family" : "Rubenstein", "given" : "Laurence Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Josephson", "given" : "Karen R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinics in geriatric medicine", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2002", "5" ] ] }, "note" : "Ref 91 and 99 post-fall anxiety", "page" : "141-58", "title" : "The epidemiology of falls and syncope.", "type" : "article-journal", "volume" : "18" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[35]", "plainTextFormattedCitation" : "[35]", "previouslyFormattedCitation" : "[35]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[35]Suboccipital headache, numbness exacerbated by Valsalva maneuversWeakness, numbness, loss of temperature sensation 90% have abnormal signs on examination including hyperreflexia and ‘cape’ sensory lossADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00013414-200109000-00005", "ISSN" : "1050-6438", "author" : [ { "dropping-particle" : "", "family" : "Meadows", "given" : "Jeffery", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guarnieri", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Miller", "given" : "Ken", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Haroun", "given" : "Raymond", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kraut", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carson", "given" : "Benjamin S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neurosurgery Quarterly", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2001", "9" ] ] }, "page" : "220-229", "title" : "Type I Chiari Malformation: A Review of the Literature", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1159/000260909", "ISSN" : "1423-0305", "PMID" : "19940537", "abstract" : "BACKGROUND: Chiari I malformation (CM1) is characterized by impaired CSF flow through the foramen magnum. Dysfunctional autonomic cardiovascular regulation may result in syncope. Syncope may be the primary presenting symptom of CM1: a syndrome termed Chiari drop attack. It has been postulated that Chiari drop attack is secondary to dysautonomia caused by hindbrain compression. There has been recent debate regarding the association between CM1, dysautonomia and Chiari drop attack. METHODS: We selected patients with Chiari drop attacks who had negative workups for cardiac syncope, followed by tilt table testing and subsequent surgical decompression. We report test results and clinical outcomes following CM1 decompression. RESULTS: Ten patients met the inclusion criteria: 5 patients had positive and 5 negative tilt table tests. Following decompression, 7 had symptomatic improvement or resolution and 3 failed to improve. The sensitivity and specificity of the tilt table test for detecting clinical improvement with surgical decompression was 43 and 33%, respectively. Tilt table testing had 40% accuracy in predicting clinical response to decompression. CONCLUSIONS: In this short series, surgical decompression of CM1 has a high success rate (70%) for patients with Chiari drop attacks. Tilt table testing has poor predictive value in judging the clinical response to surgical decompression and is not a useful test to guide surgical decision- making.", "author" : [ { "dropping-particle" : "", "family" : "Straus", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Foster", "given" : "Kimberly", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zimmerman", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Frim", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Pediatric Neurosurgery", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2009", "1" ] ] }, "page" : "384-389", "title" : "Chiari Drop Attacks: Surgical Decompression and the Role of Tilt Table Testing", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[3,19]", "plainTextFormattedCitation" : "[3,19]", "previouslyFormattedCitation" : "[3,19]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[3,19]Symptoms of raised intracranial pressureADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1054/jocn.2000.0800", "ISSN" : "0967-5868", "PMID" : "11437572", "abstract" : "This paper is a retrospective review of all patients treated for a colloid cyst of the third ventricle at Royal Prince Alfred Hospital over an 18-year consecutive period. Our experience is fairly typical compared with other published series. Colloid cys ts made up 1.6% of tumours treated by the neurosurgical unit. Patients presented with non-specific neurological symptoms and signs, commonly suggestive of raised intracranial pressure. Microsurgical excision was carried out via the transcallosal route in 34 cases and the transfrontal approach in four cases. There was no apparent difference in results from the different surgical approaches. In 86% of patients reviewed after more than 6 months good long term outcome was achieved. These benign tumours can be safely cured if the diagnosis is made early and the cyst removed by careful microsurgical techniques.", "author" : [ { "dropping-particle" : "", "family" : "Jeffree", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Besser", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2001", "7" ] ] }, "page" : "328-31", "title" : "Colloid cyst of the third ventricle: a clinical review of 39 cases.", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[27]", "plainTextFormattedCitation" : "[27]", "previouslyFormattedCitation" : "[27]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[27] e.g. headache with nausea and vomitingADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0090-3019", "PMID" : "12128295", "abstract" : "BACKGROUND: Colloid cyst of the third ventricle is a relatively rare intracranial tumor. It generates tremendous interest for the neurosurgeon because of its benign nature, deep location, and an excellent prognosis when diagnosed early and excised.\n\nMETHOD: A retrospective analysis of 105 cases of third ventricle colloid cyst treated between 1967 to 1998 was conducted. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. The transcallosal and transcortical-transventricular approaches were predominantly used. Memory and psychological assessment were carried out both pre- and postoperatively. A computerized tomography (CT) scan was performed during follow-up.\n\nRESULTS: The male to female ratio was 1.5:1. The age of the patients ranged from 10 to 68 years. Headache was the most common symptom. Papilledema and short-term memory disturbances were the most common signs. In 5 patients the colloid cyst was detected incidentally. Surgery for colloid cyst was performed in 93 patients. Transcallosal and transcortical-transventricular approaches were performed in 62 and 30 patients, respectively. In 1 patient the cyst was excised through the subfrontal lamina terminalis approach. Total excision was achieved in 90 patients, while partial cyst excision was done in three patients. Moderate to severe lateral ventricular enlargement was found in 76 patients at presentation. A ventriculoperitoneal shunt was the only surgical procedure performed in 7 patients. In 16 patients colloid cyst excision was conducted after cerebrospinal fluid (CSF) diversion via a shunt. No surgical treatment of any kind was performed in 5 patients. Five patients died. Eighty-six patients came for follow-up, with a range from 1 month to 25 years (average 3 years and 8 months). Postoperatively, transient recent memory deficits occurred in 14 patients, while a permanent recent memory loss was noted in 2 patients. There was no incidence of postoperative disconnection syndrome or behavioral disturbance. A CT scan was performed in 44 patients during follow-up. Recurrence was detected in 1 patient in whom the cyst had been partially excised.\n\nCONCLUSIONS: Colloid cyst, although a benign tumor, is surgically challenging because of its deep midline location. Early detection and total excision of the colloid cyst carries an excellent prognosis.", "author" : [ { "dropping-particle" : "", "family" : "Desai", "given" : "Ketan I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nadkarni", "given" : "Trimurti D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Muzumdar", "given" : "Dattatraya P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goel", "given" : "Atul H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgical neurology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2002", "5" ] ] }, "page" : "295-302; discussion 302-4", "title" : "Surgical management of colloid cyst of the third ventricle--a study of 105 cases.", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[20]", "plainTextFormattedCitation" : "[20]", "previouslyFormattedCitation" : "[20]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[20]Altered GCSCan be found incidentallyOccur almost exclusively in patients with other neurological abnormalitiesOften linked to severe epilepsies in childhood In parasagittal seizure foci somatosensory auras and generalized seizures usually occurADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Quesney", "given" : "L F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "M", "given" : "Constain", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fish", "given" : "D R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "T", "given" : "Rasmussen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arch Neurol", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "1990" ] ] }, "page" : "677-9", "title" : "The clinical differentiation of seizures arising in the parasagittal and anterolaterodorsal frontal convexities", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[28]", "plainTextFormattedCitation" : "[28]", "previouslyFormattedCitation" : "[28]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[28].Most commonly presents with cardioembolic stroke or symptoms of congestive heart failureADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.carpath.2013.04.006", "ISBN" : "1054-8807", "ISSN" : "10548807", "PMID" : "23727543", "abstract" : "Introduction: Primary cardiac tumors are rare entities with an autopsy frequency ranging between 0.001% and 0.3%. Our objective was to review 32 years of experience from a Spanish tertiary surgical center. Method: We collected data on 73 patients with a histopathological diagnosis of a primary cardiac tumor in a retrospective analysis from 1979 to 2012. Tissue samples were obtained either at surgery or from necropsy and subsequently divided into benign and malignant groups. Results: Benign neoplasms accounted for 84.9% of cases. The average age at diagnosis was 61 years, and tumors were twice as frequent among women. It was an incidental finding in one quarter of patients. In symptomatic patients, the typical presentation was of cardioembolic stroke or of congestive symptoms. Myxoma (93.5%) was the most common diagnosis, typically affecting the left atrium (74.2%). Surgical resection was curative for 95% of these patients. Malignant tumors represented 15.1% of cases with an average age at diagnosis of 50 years. Over 90% of these patients were symptomatic at presentation with the cardinal symptom being heart failure. Undifferentiated sarcoma was the most frequent malignant tumor (36.4%). Less than 20% of patients were alive 1 year after diagnosis despite the treatment. Conclusions: In our study, primary cardiac tumors were insidious. The most common was left atrial myxoma in which surgical resection was considered curative. Undifferentiated sarcoma was the most frequent malignant tumor. Malignant neoplasms carried a worse prognosis with unsuccessful total excision and the presence of metastatic disease being markers of an adverse outcome. ?? 2013 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Barreiro", "given" : "Manuel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Renilla", "given" : "Alfredo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jimenez", "given" : "Jaime M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "Mar??a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Musa", "given" : "Tarique", "non-dropping-particle" : "Al", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garcia", "given" : "Laura", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barriales", "given" : "Vicente", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovascular Pathology", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "424-427", "publisher" : "Elsevier Inc.", "title" : "Primary cardiac tumors: 32 Years of experience from a Spanish tertiary surgical center", "type" : "article-journal", "volume" : "22" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[23]", "plainTextFormattedCitation" : "[23]", "previouslyFormattedCitation" : "[23]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[23] Angina, pyrexia and palpitations may co-occurADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ijcard.2008.11.103", "ISBN" : "0003-4932 (Print)\\r0003-4932 (Linking)", "ISSN" : "01675273", "PMID" : "19128845", "abstract" : "Primary cardiac tumors are a rare entity compared to tumors that metastasize to the heart. Patients with such tumors may be asymptomatic. Many cases are found incidentally during evaluation of an unrelated medical condition. It is important for the clinician to have a high index of suspicion when evaluating a patient presenting with signs and systemic symptoms concerning possible malignancy, plus cardiac specific symptoms or complications. These can include new onset dyspnea, congestive heart failure, arrhythmias or murmurs varying with body positions. Imaging, particularly the use of echocardiography, remains the cornerstone of diagnosis, and may be combined with new imaging modalities of cardiac CT and MRI. The aim of this paper is to describe the epidemiology and pathophysiology of the various benign and malignant primary cardiac tumors. ?? 2008 Elsevier Ireland Ltd. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Maraj", "given" : "Suraj", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pressman", "given" : "Gregg S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Figueredo", "given" : "Vincent M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Cardiology", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "152-156", "publisher" : "Elsevier Ireland Ltd", "title" : "Primary Cardiac Tumors", "type" : "article-journal", "volume" : "133" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[32]", "plainTextFormattedCitation" : "[32]", "previouslyFormattedCitation" : "[32]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[32]TriggerOften triggered by fall or faint which is different from ongoing drop attacksMore common during exerciseOccurs on head turning, shaving, or when wearing a tight collar?None?NoneUnclear, controversy about link with orthostatic intoleranceADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s10286-002-0051-9", "ISBN" : "0959-9851 (Print)\\r0959-9851 (Linking)", "ISSN" : "09599851", "PMID" : "12598952", "abstract" : "Orthostatic intolerance, seen predominantly in young women, is characterized by symptoms of lightheadedness, fatigue and palpitations in the upright posture. With standing, plasma norepinephrine levels rise dramatically and heart rate often increases by more than 30 beats per minute, although blood pressure does not usually fall. A theory recently popularized in the media suggests that some cases of orthostatic intolerance are related to hindbrain compression, with or without a Chiari I malformation. As a preliminary investigation of this hypothesis, head or cervical spine MRI scans from 23 females with orthostatic intolerance were reviewed. The cerebellar tonsils averaged 0.3 +/- 1.9 mm below the foramen magnum. These results were compared to measurements from a control group averaging 0.4 +/- 2.6 mm above the foramen magnum (P > 0.05). Tonsillar depression of at least 3 mm occurred in 13 % of both the patient group and the control group. Tonsillar herniation was not found to influence supine or upright blood pressure, heart rate or plasma norepinephrine levels in the patients. We conclude that herniation of the cerebellar tonsils is not a common cause of orthostatic intolerance. However, the single measurement of tonsillar depression might underestimate the number of patients with hindbrain compression.", "author" : [ { "dropping-particle" : "", "family" : "Garland", "given" : "Emily M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "James C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black", "given" : "Bonnie K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kessler", "given" : "Robert M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Konrad", "given" : "Peter E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Robertson", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Autonomic Research", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "472-476", "title" : "No increased herniation of the cerebellar tonsils in a group of patients with orthostatic intolerance", "type" : "article-journal", "volume" : "12" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[29]", "plainTextFormattedCitation" : "[29]", "previouslyFormattedCitation" : "[29]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[29]?None statedUsual triggers for seizures e.g. withdrawal of anticonvulsants?NoneLong term outcomeCan resolve spontaneously or be present for years without escalation.Patients may develop dissociative attacks.Depends on aetiology. Causes are:Structural heart disease, Brady/tachy-arrhytmias or inherited channelopathiesOver 50% of patients suffer serious injury due to fallHigh rate of recurrenceOccurs frequently during the first year of symptoms then spontaneously remitsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/00016480701767390", "ISSN" : "0001-6489", "PMID" : "18607945", "abstract" : "CONCLUSION: The otolithic organs of patients with vestibular drop attack (VDA) secondary to Meniere's disease were damaged but the damage was not complete. In other words, the otolithic functions of patients with VDA were unstable. OBJECTIVE: To evaluate otolithic function using vestibular evoked myogenic potential (VEMP) in patients with VDA secondary to Meniere's disease. PATIENTS AND METHODS: Clinical records of three patients with VDA secondary to Meniere's disease were reviewed with special reference to VEMP testing. RESULTS: The three patients were classified as stage II or III Meniere's disease. A long-term follow-up of VEMP in two patients showed reversible changes of VEMP reflexes, and VEMP testing with glycerol administration in two patients revealed the recovery of VEMP responses after taking glycerol, and the existence of saccular endolymphatic hydrops.", "author" : [ { "dropping-particle" : "", "family" : "Ozeki", "given" : "Hidenori", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Iwasaki", "given" : "Shinichi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murofushi", "given" : "Toshihisa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Acta Oto-Laryngologica", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2008", "1", "8" ] ] }, "page" : "887-891", "title" : "Vestibular drop attack secondary to Meniere's disease results from unstable otolithic function", "type" : "article-journal", "volume" : "128" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[2]", "plainTextFormattedCitation" : "[2]", "previouslyFormattedCitation" : "[2]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[2]At increased risk of MI, IHD and strokeWill usually develop other neurological symptomsSymptomatic cysts can lead to raised ICP and death if untreated.>80% of patients treated with microsurgery have a good long term outcomeADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.surneu.2007.11.005", "ISBN" : "0090-3019 (Print)", "ISSN" : "00903019", "PMID" : "18295836", "abstract" : "Background: Colloid cysts are rare tumors (incidence 3.2/1 000 000 pear year) located in the anterosuperior part of the third ventricle. In this article, we present our microneurosurgical experience on 134 patients focusing on the nuances of ITA with demonstrative videoclips. Methods: This surgical series is based on the microsurgical experience of the senior author (JH) at 2 Finnish neurosurgical centers (Helsinki and Kuopio, 1980-2007). Surgical anatomy is demonstrated, and the pitfalls of the different surgical steps are analyzed to avoid complications. The series reflects the whole patient profile of Southern and Eastern Finland, without any selection bias. Results: There was no surgical mortality, and morbidity remained mainly transitory among 134 patients treated by ITA. Conclusions: Favorable overall outcome of this series demonstrates that removal of third ventricular colloid cyst via transcallosal approach is a direct and safe way to treat these lesions. \u00a9 2008.", "author" : [ { "dropping-particle" : "", "family" : "Hernesniemi", "given" : "Juha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Romani", "given" : "Rossana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dashti", "given" : "Reza", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albayrak", "given" : "Baki S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Savolainen", "given" : "Sakari", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ramsey", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Karatas", "given" : "Ayse", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lehto", "given" : "Hanna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Navratil", "given" : "Ondrej", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Niemel\u00e4", "given" : "Mika", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgical Neurology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "447-453", "title" : "Microsurgical treatment of third ventricular colloid cysts by interhemispheric far lateral transcallosal approach-experience of 134 patients", "type" : "article-journal", "volume" : "69" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[30]", "plainTextFormattedCitation" : "[30]", "previouslyFormattedCitation" : "[30]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[30],ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0090-3019", "PMID" : "12128295", "abstract" : "BACKGROUND: Colloid cyst of the third ventricle is a relatively rare intracranial tumor. It generates tremendous interest for the neurosurgeon because of its benign nature, deep location, and an excellent prognosis when diagnosed early and excised.\n\nMETHOD: A retrospective analysis of 105 cases of third ventricle colloid cyst treated between 1967 to 1998 was conducted. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. The transcallosal and transcortical-transventricular approaches were predominantly used. Memory and psychological assessment were carried out both pre- and postoperatively. A computerized tomography (CT) scan was performed during follow-up.\n\nRESULTS: The male to female ratio was 1.5:1. The age of the patients ranged from 10 to 68 years. Headache was the most common symptom. Papilledema and short-term memory disturbances were the most common signs. In 5 patients the colloid cyst was detected incidentally. Surgery for colloid cyst was performed in 93 patients. Transcallosal and transcortical-transventricular approaches were performed in 62 and 30 patients, respectively. In 1 patient the cyst was excised through the subfrontal lamina terminalis approach. Total excision was achieved in 90 patients, while partial cyst excision was done in three patients. Moderate to severe lateral ventricular enlargement was found in 76 patients at presentation. A ventriculoperitoneal shunt was the only surgical procedure performed in 7 patients. In 16 patients colloid cyst excision was conducted after cerebrospinal fluid (CSF) diversion via a shunt. No surgical treatment of any kind was performed in 5 patients. Five patients died. Eighty-six patients came for follow-up, with a range from 1 month to 25 years (average 3 years and 8 months). Postoperatively, transient recent memory deficits occurred in 14 patients, while a permanent recent memory loss was noted in 2 patients. There was no incidence of postoperative disconnection syndrome or behavioral disturbance. A CT scan was performed in 44 patients during follow-up. Recurrence was detected in 1 patient in whom the cyst had been partially excised.\n\nCONCLUSIONS: Colloid cyst, although a benign tumor, is surgically challenging because of its deep midline location. Early detection and total excision of the colloid cyst carries an excellent prognosis.", "author" : [ { "dropping-particle" : "", "family" : "Desai", "given" : "Ketan I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nadkarni", "given" : "Trimurti D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Muzumdar", "given" : "Dattatraya P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goel", "given" : "Atul H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgical neurology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2002", "5" ] ] }, "page" : "295-302; discussion 302-4", "title" : "Surgical management of colloid cyst of the third ventricle--a study of 105 cases.", "type" : "article-journal", "volume" : "57" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[20]", "plainTextFormattedCitation" : "[20]", "previouslyFormattedCitation" : "[20]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[20]Falls can lead to injurySeizure frequency often highLife-threatening complications can occur if symptomatic tumors are left untreatedAsymptomatic tumors often have good long term prognosisTreatmentNo good evidenceWe suggest trials of:Distraction techniques, CBT, physiotherapyStructural disease and inherited channelopathies: implantable defibrillatorBrady/tachy-arrhytmias: PacemakerPacemakerConservative management, Intratympanic gentamycin injectionADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Meniere\u2019s disease is a chronic illness that aff ects a substantial number of patients every year worldwide. The disease is characterised by intermittent episodes of vertigo lasting from minutes to hours, with fl uctuating sensorineural hearing loss, tinnitus, and aural pressure. Although there is currently no cure, more than 85% of patients with Meniere\u2019s disease are helped by either changes in lifestyle and medical treatment, or minimally invasive surgical procedures such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. Vestibular neurectomy has a very high rate of vertigo control and is available for patients with good hearing who have failed all other treatments. Labyrinthectomy is undertaken as a last resort and is best reserved for patients with unilateral disease and deafness. Introduction", "author" : [ { "dropping-particle" : "", "family" : "Hain", "given" : "Timothy C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "406-14", "title" : "Meniere \u2019 s Disease", "type" : "article-journal", "volume" : "372" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[18]", "plainTextFormattedCitation" : "[18]", "previouslyFormattedCitation" : "[18]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[18]Thrombolysis, antiplatelet agents and management of cardiovascular risk factors.May require operative management if clinically deterioratingSymptomatic or large cysts require operation.AnticonvulsantsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1528-1167.2009.02231.x", "ISSN" : "00139580", "PMID" : "19702729", "abstract" : "Tonic and atonic seizures are typically seen in what are often referred to as the catastrophic epilepsies. In simply considering what each of the terms signifies (either the complete loss of tone or a marked increase in tone), they would appear to be at the most diverse ends of the spectrum. They would appear to be as opposite as hot and cold or hard and soft. And yet they are often found to occur in the same patient. This article examines the nature of these seizures and discusses some of the syndromes in which they are seen. Although these seizures are often very difficult to control, some of our medications/therapies have been shown to be effective. Recommendations concerning the efficacy of these therapies and a review of the newer therapies are provided. In addition, the ketogenic diet has been particularly successful in treating these seizures; this is discussed in some detail. Finally, although outcomes for these children are generally less than ideal, many can be helped with a persistent approach that balances seizure control against the side effects of medication.", "author" : [ { "dropping-particle" : "", "family" : "Vining", "given" : "Eileen P G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsia", "id" : "ITEM-1", "issue" : "SUPPL. 8", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "21-24", "title" : "Tonic and atonic seizures: Medical therapy and ketogenic diet", "type" : "article-journal", "volume" : "50" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[21]", "plainTextFormattedCitation" : "[21]", "previouslyFormattedCitation" : "[21]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[21],ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1528-1167.2011.03075.x", "ISSN" : "1528-1167", "PMID" : "21729037", "abstract" : "PURPOSE: Long-term medical management of epileptic drop attacks is usually unsatisfactory and more effective antiepileptic drug (AED) regimens are needed. The present study aimed at providing proof of concept that previously refractory epileptic drop attacks could be significantly and safely controlled by the specific combination of valproate, lamotrigine, and a benzodiazepine.\n\nMETHODS: An open label trial providing class IV evidence of efficacy, including 32 patients with cryptogenic/symptomatic, generalized or multifocal epilepsies, and refractory drop attacks. Following baseline, the combination under study was introduced and patients followed for 12 months. Frequency of drop attacks was compared at 3-month intervals with that during baseline and correlated with clinical, electroencephalography (EEG), and imaging variables. A list of putative side effects was read to patients and caregivers at each visit.\n\nKEY FINDINGS: Four patients were excluded, one due to a Stevens-Johnson syndrome (SJS). Median number of drop attacks decreased 96% between baseline and the fourth trimester of the study (from 50 to 2; p<0,001). Intention-to-treat (ITT) analysis showed that 15 patients (47%) had complete control, 7 (21%) had a 75% and 5 (15%) had a 50-74% reduction in the frequency of falls in the fourth trimester. Twenty-two patients (68%) had side effects, but except for the three excluded because of early rash, caregivers did not consider discontinuation. Mean final dose of valproate was 35.9 mg/kg/day and that of lamotrigine 4.9 mg/kg/day. Twenty patients used clobazam, eight nitrazepam, and the other four clonazepam as the elected benzodiazepine. Outcome did not correlate with clinical, EEG, and imaging variables.\n\nSIGNIFICANCE: This open label study suggests that the combination of valproate, lamotrigine, and a benzodiazepine can markedly reduce the frequency of epileptic drop attacks in patients with generalized or multifocal epilepsies. Careful clinical monitoring for early signs of SJS is needed.", "author" : [ { "dropping-particle" : "", "family" : "Machado", "given" : "Vitor Hugo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palmini", "given" : "Andre", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bastos", "given" : "Fernanda Almeida", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rotert", "given" : "Rosana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Epilepsia", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2011", "7" ] ] }, "page" : "1303-10", "title" : "Long-term control of epileptic drop attacks with the combination of valproate, lamotrigine, and a benzodiazepine: a 'proof of concept,' open label study.", "type" : "article-journal", "volume" : "52" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[31]", "plainTextFormattedCitation" : "[31]", "previouslyFormattedCitation" : "[31]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[31]Complete surgical excision can be carried out in most casesADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.carpath.2011.12.004", "ISBN" : "19362625", "ISSN" : "10548807", "PMID" : "22300501", "abstract" : "Background: Tumors of the heart are rare compared to other cardiac diseases. Their clinical symptoms vary from absent to nonspecific. This great variation and general paucity of symptoms related to cardiac tumors often result in delayed diagnosis and treatment. Methods: We retrospectively evaluated all patients who underwent cardiac surgery for a space-occupying lesion in the observation period between 2000 and 2010 at our hospital. Clinicopathological features, imaging characteristics, and disease outcomes were analyzed, and the results were compared with the available English literature. Results: During the last 10 years, 84 patients underwent resection of a cardiac mass at our center, i.e., 0.85% of the total number (n=9829) of all cardiac surgical operations performed in that period. The part of primary cardiac tumors was 73.8% (n=62; 59 benign and 3 malign tumors). In nine cases (10.7%), secondary cardiac tumors represented metastases of malignant tumors from different extracardiac locations. In 13 cases (15.5%), the mass represented cardiac thrombus. The majority of cardiac tumors were benign, and most of them were cardiac myxomas (n=48). Papillary fibroelastoma was the second most common primary tumor. Conclusions: Our data in this study were comparable to the literature regarding the frequency and allocation of the different cardiac tumors. Our data are in line with previous reports that patients with benign cardiac tumors profit from surgical resection compared to those subjected to conservative treatment with the risk of central or peripheral embolisms. Concerning malignant primary cardiac tumors and cardiac metastases, surgery represents only a palliative strategy in most of the cases. \u00a9 2012 Elsevier Inc. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Strecker", "given" : "Thomas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "R\u00f6sch", "given" : "Johannes", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weyand", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Agaimy", "given" : "Abbas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovascular Pathology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "436-443", "publisher" : "Elsevier Inc.", "title" : "Primary and metastatic cardiac tumors: Imaging characteristics, surgical treatment, and histopathological spectrum: A 10-year-experience at a German heart center", "type" : "article-journal", "volume" : "21" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "[22]", "plainTextFormattedCitation" : "[22]", "previouslyFormattedCitation" : "[22]" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }[22]REFERENCESADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1 Stevens DL, Matthews WB. 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