![]() A patient presenting with acute recurrent falls without alteration of consciousness and with unremarkable cardiac, neurological, and electrophysiological testing should prompt consideration of cataplexy and narcolepsy. Conversion reaction may simulate a drop attack and can be inferred by the exclusion of neurological disease, the exclusion of feigning, and determination of a psychological mechanism. ![]() In the majority (64%) of these cases, the etiology of DA is not clearly established. ![]() Occasionally, recurrent falls occur without alteration of consciousness. The presence of vertigo is suggestive of a vestibulopathy or central nervous system process. It is important to distinguish between sensations of lightheadedness and spinning (vertigo). Also, patients with vertigo can be subject to falls. Absence of epileptogenic activity during an attack suggests nonepileptic origin, but a normal interictal EEG does not rule out epilepsy. If there is clinical suspicion of epilepsy, brain imaging and electroencephalogram (EEG) are useful diagnostic tools. The evaluation of these patients includes history, physical examination, and 12-lead electrocardiography, supplemented when warranted by echocardiography, tilt table testing, stress testing, and event recordings.įalls may also result from seizures. ![]() These conditions can also cause episodes of presyncope in which patients experience DA with lightheadedness rather than loss of consciousness. Causes of syncope include arrhythmias, aortic stenosis, orthostatic hypotension, neurally mediated syncope, subclavian steal, and other disorders. In patients with syncope, DAs are associated with transient loss of consciousness. Introductionĭrop attacks (DAs) are spontaneous falls that are followed by quick recovery. Isolated cataplexy should be included in the differential diagnosis when a patient presents with recurrent drop attacks and normal diagnostic test results. We report a patient with the rare condition of cataplexy without associated narcolepsy (isolated cataplexy). Cataplexy, which is usually associated with narcolepsy, is one of the causes of drop attacks. 2015 7:81-83.Drop attacks are sudden spontaneous falls that are not accompanied by alteration of consciousness and are followed by immediate recovery. Baclofen for narcolepsy with cataplexy: two cases. The distinguishing motor features of cataplexy: a study from video-recorded attacks. Clinical features, diagnosis and treatment of narcolepsy. Life effects of narcolepsy in 180 patients from North America, Asia and Europe compared to matched controls. Broughton R, Ghanem Q, Hishikawa Y, et al.The clinical features of cataplexy: a questionnaire study in narcolepsy patients with and without hypocretin-1 deficiency. Overeem S, van Nues S, van der Zande WL, Donjacour CE, van Mierlo P, Lammers GJ.Cataplexy-clinical aspects, pathophysiology and management strategy. Dauvilliers Y, Siegel JM, Lopez R, Torontali ZA, Peever JH. ![]() Listening to the patient voice in narcolepsy: diagnostic delay, disease burden, and treatment efficacy.
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