Drop attack

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A drop attack is a sudden fall without loss of consciousness. Drop attacks stem from diverse mechanisms, including orthopedic causes (for example, leg weakness and knee instability), hemodynamic causes (for example, transient vertebrobasilar insufficiency, a type of interruption of blood flow to the brain), and neurologic causes (such as epileptic seizures or unstable vestibular function), among other reasons. Those affected typically experience abrupt leg weakness, sometimes after sudden movement of the head. The weakness may persist for hours.

The term "drop attack", also known as "cryptogenic drop attack" or "La maladie des genoux bleus"; [1] [2] [3] is used to categorize otherwise unexplained falls from a wide variety of causes and is considered ambiguous medical terminology; drop attacks are currently reported much less often than in the past, possibly as a result of better diagnostic precision. [4] [5] By definition, drop attacks exclude syncopal falls (fainting), which involve short loss of consciousness. In neurology, the term "drop attack" is used to describe certain types of seizure which occur in epilepsy. [6] [7] Drop attacks that have a vestibular origin within the inner ear may be experienced by some people in the later stages of Ménière's disease (these may be referred to as Tumarkin [drop] attacks, or as Tumarkin's otolithic crisis). [8] [9]

Drop attacks often occur in elderly people; with a majority of documented cases occurring in women. [10] [11] [12] [13] Falls in older adults happen for many reasons, and the goals of health care include preventing any preventable falls and correctly diagnosing any falls that do happen.

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<span class="mw-page-title-main">Epilepsy</span> Group of neurological disorders causing seizures

Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. An epileptic seizure is the clinical manifestation of an abnormal, excessive, and synchronized electrical discharge in the neurons. The occurrence of two or more unprovoked seizures defines epilepsy. The occurrence of just one seizure may warrant the definition in a more clinical usage where recurrence may be able to be prejudged. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly, such as broken bones, or through causing accidents. In epilepsy, seizures tend to recur and may have no detectable underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.

<span class="mw-page-title-main">Seizure</span> Period of symptoms due to excessive or synchronous neuronal brain activity

A seizure is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness, to shaking movements involving only part of the body with variable levels of consciousness, to a subtle momentary loss of awareness. These episodes usually last less than two minutes and it takes some time to return to normal. Loss of bladder control may occur.

<span class="mw-page-title-main">Ménière's disease</span> Disorder of the inner ear

Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initially, but over time, both ears may become involved. Episodes generally last from 20 minutes to a few hours. The time between episodes varies. The hearing loss and ringing in the ears can become constant over time.

Absence seizures are one of several kinds of generalized seizures. In the past, absence epilepsy was referred to as "pyknolepsy," a term derived from the Greek word "pyknos," signifying "extremely frequent" or "grouped". These seizures are sometimes referred to as petit mal seizures ; however, usage of this terminology is no longer recommended. Absence seizures are characterized by a brief loss and return of consciousness, generally not followed by a period of lethargy. Absence seizures are most common in children. They affect both sides of the brain.

<span class="mw-page-title-main">Dizziness</span> Neurological condition causing impairment in spatial perception and stability

Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness.

<span class="mw-page-title-main">Aura (symptom)</span> Symptom of epilepsy and migraine

An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is actually a minor seizure.

Psychogenic non-epileptic seizures (PNES), also referred to as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND), also known as conversion disorders, and are typically treated by psychologists or psychiatrists. PNES has previously been called stress seizures and hysterical seizures, but these terms have fallen out of favor.

Non-epileptic seizures (NES), also known as non-epileptic events, are paroxysmal events that appear similar to an epileptic seizure but do not involve abnormal, rhythmic discharges of neurons in the brain. Symptoms may include shaking, loss of consciousness, and loss of bladder control.

<span class="mw-page-title-main">Vertigo</span> Type of dizziness where a person has the sensation of moving or surrounding objects moving

Vertigo is a condition in which a person has the sensation that they are moving, or that objects around them are moving, when they are not. Often it feels like a spinning or swaying movement. It may be associated with nausea, vomiting, perspiration, or difficulties walking. It is typically worse when the head is moved. Vertigo is the most common type of dizziness.

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Epileptic spasms is an uncommon-to-rare epileptic disorder in infants, children and adults. One of the other names of the disorder, West syndrome, is in memory of the English physician, William James West (1793–1848), who first described it in an article published in The Lancet in 1841. The original case actually described his own son, James Edwin West (1840–1860). Other names for it are "generalized flexion epilepsy", "infantile epileptic encephalopathy", "infantile myoclonic encephalopathy", "jackknife convulsions", "massive myoclonia" and "Salaam spasms". The term "infantile spasms" can be used to describe the specific seizure manifestation in the syndrome, but is also used as a synonym for the syndrome itself. West syndrome in modern usage is the triad of infantile spasms, a pathognomonic EEG pattern, and developmental regression – although the international definition requires only two out of these three elements.

<span class="mw-page-title-main">Otolithic membrane</span>

The otolithic membrane is a fibrous structure located in the vestibular system of the inner ear. It plays a critical role in the brain's interpretation of equilibrium. The membrane serves to determine if the body or the head is tilted, in addition to the linear acceleration of the body. The linear acceleration could be in the horizontal direction as in a moving car or vertical acceleration such as that felt when an elevator moves up or down.

<span class="mw-page-title-main">Health of Vincent van Gogh</span> Historical line of inquiry

There is no consensus on Vincent van Gogh's health. His death in 1890 is generally accepted to have been a suicide. Many competing hypotheses have been advanced as to possible medical conditions that he may have had. These include epilepsy, bipolar disorder, borderline personality disorder, sunstroke, acute intermittent porphyria, lead poisoning, Ménière's disease, schizophrenia, schizoaffective disorder, substance use disorder, non-suicidal self-injury disorder ("self-harm"), and a possible anxiety disorder.

In the field of neurology, seizure types are categories of seizures defined by seizure behavior, symptoms, and diagnostic tests. The International League Against Epilepsy (ILAE) 2017 classification of seizures is the internationally recognized standard for identifying seizure types. The ILAE 2017 classification of seizures is a revision of the prior ILAE 1981 classification of seizures. Distinguishing between seizure types is important since different types of seizures may have different causes, outcomes, and treatments.

Abdominal epilepsy is a rare condition most frequently found in children, consisting of gastrointestinal disturbances caused by epileptiform seizure activity. Though a few cases of it have been reported in adults too. It has been described as a type of temporal lobe epilepsy. Responsiveness to anticonvulsants can aid in the diagnosis. Distinguishing features of abdominal epilepsy include (1) Abnormal laboratory, radiographic, and endoscopic findings revealing paroxysmal GI manifestations of unknown origin (2) CNS symptoms (3) Abnormal EEG. Most published medical literature dealing with abdominal epilepsy is in the form of individual case reports. A 2005 review article found a total of 36 cases described in the medical literature.

Juvenile myoclonic epilepsy (JME), also known as Janz syndrome or impulsive petit mal, is a form of hereditary, idiopathic generalized epilepsy, representing 5–10% of all epilepsy cases. Typically it first presents between the ages of 12 and 18 with myoclonic seizures. These events typically occur after awakening from sleep, during the evening or when sleep-deprived. JME is also characterized by generalized tonic–clonic seizures, and a minority of patients have absence seizures. It was first described by Théodore Herpin in 1857. Understanding of the genetics of JME has been rapidly evolving since the 1990s, and over 20 chromosomal loci and multiple genes have been identified. Given the genetic and clinical heterogeneity of JME some authors have suggested that it should be thought of as a spectrum disorder.

Sleep-related hypermotor epilepsy (SHE), previously known as nocturnal frontal lobe epilepsy, is a form of focal epilepsy characterized by seizures which arise during sleep. The seizures are most typically characterized by complex motor behaviors. It is a relatively uncommon form of epilepsy that constitutes approximately 9-13% of cases. This disorder is associated with cognitive impairment in at least half of patients as well as excessive daytime sleepiness due to poor sleep quality. This disorder is sometimes misdiagnosed as a non-epileptic sleep disorder. There are many potential causes of SHE including genetic, acquired injuries and structural abnormalities.

Abdominal aura, also known as visceral aura and epigastric aura, is a type of somatosensory aura that typically manifests as abdominal discomfort in the form of nausea, malaise, hunger, or pain. Abdominal aura is typically associated with epilepsy, especially temporal lobe epilepsy, and it can also be used in the context of migraine. The term is used to distinguish it from other types of somatosensory aura, notably visual disturbances and paraesthesia. The abdominal aura can be classified as a somatic hallucination. Pathophysiologically, the abdominal aura is associated with aberrant neuronal discharges in sensory cortical areas representing the abdominal viscera.

Functional neurologic disorder or functional neurological disorder (FND) is a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms, and blackouts. As a functional disorder, there is, by definition, no known disease process affecting the structure of the body, yet the person experiences symptoms relating to their body function. Symptoms of functional neurological disorders are clinically recognisable, but are not categorically associated with a definable organic disease.

Drug-resistant epilepsy (DRE), also known as refractory epilepsy, intractable epilepsy, or pharmacoresistant epilepsy, is diagnosed following a failure of adequate trials of two tolerated and appropriately chosen and used antiepileptic drugs (AEDs) to achieve sustained seizure freedom. The probability that the next medication will achieve seizure freedom drops with every failed AED. For example, after two failed AEDs, the probability that the third will achieve seizure freedom is around 4%. Drug-resistant epilepsy is commonly diagnosed after several years of uncontrolled seizures, however, in most cases, it is evident much earlier. Approximately 30% of people with epilepsy have a drug-resistant form.

References

  1. ↑ Stevens, D. L.; Matthews, W. B. (1973-02-24). "Cryptogenic Drop Attacks: An Affliction of Women". Br Med J. 1 (5851): 439–442. doi:10.1136/bmj.1.5851.439. ISSN   0007-1447. PMC   1588502 . PMID   4689829.
  2. ↑ Butsch, Raphael; Schneemann, Markus (2014-06-27). "Two women with recurrent falls: La maladie des genoux bleus alias cryptogenic drop attacks". Case Reports. 2014: bcr2013200855. doi:10.1136/bcr-2013-200855. ISSN   1757-790X. PMC   4078483 . PMID   24973344.
  3. ↑ Revell, Emily R.; Gillespie, David; Morris, Paul G.; Stone, Jon (2021-01-01). "Drop attacks as a subtype of FND: A cognitive behavioural model using grounded theory". Epilepsy & Behavior Reports. 16: 100491. doi:10.1016/j.ebr.2021.100491. ISSN   2589-9864. PMC   8550987 . PMID   34746733.
  4. ↑ Rubenstein, L. Z. (1 September 2006). "Falls in older people: epidemiology, risk factors and strategies for prevention". Age and Ageing. 35 (Supplement 2): ii37–ii41. doi: 10.1093/ageing/afl084 . PMID   16926202.
  5. ↑ Bisdorff, A; Von Brevern, M; Lempert, T; Newman-Toker, DE (2009). "Classification of vestibular symptoms: towards an international classification of vestibular disorders". Journal of Vestibular Research: Equilibrium & Orientation. 19 (1–2): 1–13. doi: 10.3233/VES-2009-0343 . PMID   19893191.
  6. ↑ Zamponi, N.; Passamonti, C.; Cesaroni, E.; Trignani, R.; Rychlicki, F. (2011). "Effectiveness of vagal nerve stimulation (VNS) in patients with drop-attacks and different epileptic syndromes". Seizure. 20 (6): 468–474. doi: 10.1016/j.seizure.2011.02.011 . PMID   21396833.
  7. ↑ Abd-El-Barr, Muhammad M.; Joseph, Jacob R.; Schultz, Rebecca; Edmonds, Joseph L.; Wilfong, Angus A.; Yoshor, Daniel (2010). "Vagus nerve stimulation for drop attacks in a pediatric population". Epilepsy & Behavior. 19 (3): 394–399. doi:10.1016/j.yebeh.2010.06.044. PMID   20800554. S2CID   13346234.
  8. ↑ Ruckenstein, MJ; Shea, JJ Jr (1999). Harris, JP (ed.). Meniere's Disease. Kugler Publications. p. 266. ISBN   978-90-6299-162-4.
  9. ↑ Hayback, PJ (2012-03-06). "Mèniére's Disease". vestibular.org. Vestibular Disorders Association. Retrieved 22 September 2015.
  10. ↑ Revell, Emily R.; Gillespie, David; Morris, Paul G.; Stone, Jon (2021-01-01). "Drop attacks as a subtype of FND: A cognitive behavioural model using grounded theory". Epilepsy & Behavior Reports. 16: 100491. doi:10.1016/j.ebr.2021.100491. ISSN   2589-9864. PMC   8550987 . PMID   34746733.
  11. ↑ Hoeritzauer, Ingrid; Carson, Alan; Stone, Jon (2016-12-01). ""Cryptogenic Drop Attacks" Revisited". Journal of Neurology, Neurosurgery & Psychiatry. 87 (12): e1. doi:10.1136/jnnp-2016-315106.45. ISSN   0022-3050.
  12. ↑ Stevens, D. L.; Matthews, W. B. (1973-02-24). "Cryptogenic Drop Attacks: An Affliction of Women". Br Med J. 1 (5851): 439–442. doi:10.1136/bmj.1.5851.439. ISSN   0007-1447. PMC   1588502 . PMID   4689829.
  13. ↑ Butsch, Raphael; Schneemann, Markus (2014-06-27). "Two women with recurrent falls: La maladie des genoux bleus alias cryptogenic drop attacks". Case Reports. 2014: bcr2013200855. doi:10.1136/bcr-2013-200855. ISSN   1757-790X. PMC   4078483 . PMID   24973344.


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