Transitional loss of consciousness as an interdisciplinary problem of diagnosis
https://doi.org/10.31363/2313-7053-2023-812
Abstract
The review is devoted to the classification, diagnosis and differential diagnosis of transient loss of consciousness. The pathophysiology of transient loss of consciousness is described. It is concluded that the criteria for the differential diagnosis of transient disorders of consciousness need further development and validation. The problem of paroxysmal disorders of consciousness is interdisciplinary in nature and requires the combined efforts of doctors of different specialties to develop a unified algorithm for clinical, laboratory and instrumental diagnostics, determine management tactics and correct patient routing.
About the Authors
N. N. Petrova
Saint Petersburg State University
Russian Federation
Russian Federation
Nataliya N. Petrova
Saint Petersburg
N. V. Semenova
V.M. Bekhterev National Medical Research Center for Psychiatry and neurology
Russian Federation
Russian Federation
Nataliya V. Semenova
Saint Petersburg
References
1. Gognieva DG, Shchekochikhin DYu, Gavrilova EV, Syrkina EA, Bogdanova RS, Syrkin AL, Kopylov PhYu. THe problem of adherence to treatment in general medical practice. Kardiologiya i serdechno-sosudistaya hirurgiya. 2019;12(6):510-515. (In Russ.). https://doi.org/10.17116/kardio201912061510
2. Gorokhovskaya GN, Nikolin OP, Yun VL, Sokolov ES. Fainting is an interdisciplinary problem. Arhiv» vnutrennej mediciny. 2013;(6):25-30. (In Russ.). https://doi.org/10.20514/2226-6704-2013-0-6-25-30
3. Zhienbaeva BS, Mazhirova TB. Paroxysmal conditions in adults. Vestnik KazNMU. 2021;3:269-272. https://doi.org/10.53065/kaznmu.2021.91.15.051
4. Likhachev SA, Rybakova VD. Bioelectric activity of the brain in patients with epilepsy and neurogenic syncope. Nevrologiya i nejrohirurgiya. Vostochnaya Evropa. 2013;1(17):110-124. (In Russ.).
5. Angus-Leppan H. Diagnosing epilepsy in neurology clinics: a prospective study. Seizure. 2008;17:431–6. https://doi.org/10.1016/j.seizure.2007.12.010.
6. Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry. 2010;81(7):719–25. https://doi.org/10.1136/jnnp.2009.197996.
7. Baron-Esquivias G, Martínez-Alday J, Martín A, et al. Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study. EP Eur. 2010;12(6):869–76. https://doi.org/10.1093/europace/euq018.
8. Beghi M, Cornaggia I, Diotti S, Erba G, Harder G, Magaudda A, Laganà A, Vitale C, Cornaggia CM. THe semantics of epileptic and psychogenic nonepileptic seizures and their differential diagnosis. Epilepsy Behav. 2020;111:107250. https://doi.org/10.1016/j.yebeh.2020.107250.
9. Benbadis SR, O’Neill E, Tatum WO, Heriaud L. Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center. Epilepsia. 2004;45:1150–1153. https://doi.org/10.1111/j.0013-9580.2004.14504.x.
10. Binzer M, Stone J, Sharpe M. Recent onset pseudoseizures — clues to aetiology. Seizure 2004;13:146–55. https://doi.org/10.1016/S1059-1311(03)00184-5.
11. Bright TJ, Wong A, Dhurjati R, et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med 2012;157(1):29. https://doi.org/10.7326/0003-4819-157-1-201207030-00450.
12. Brignole M., Moya A., de Lange F.J., Deharo J., Elliott P.М., Fanciulli A., Fedorowski A., Furlan R., Kenny R.A., Martin A., Probst V., Reed M.J., Rice C.P., Sutton R., Ungar A., van Dijk J.G. Рекомендации ЕОК по диагностике и лечению синкопальных состояний 2018. Российский кардиологический журнал. 2019;(7):130-194.
13. Brignole M, Moya A, de Lange FJ, Deharo J, Elliott PM, Fanciulli A, Fedorowski A, Furlan R, Kenny RA, Martin A, Probst V, Reed MJ, Rice CP, Sutton R, Ungar A, van Dijk JG. 2018 ESC Guidelines for the diagnosis and management of syncope. Rossijskij kardiologicheskij zhurnal. 2019;(7):130-194. (In Russ.). https://doi.org/10.15829/1560-4071-2019-7-130-194
14. Brigo F, Ausserer H, Nardone R, Tezzon F, Manganotti P, Bongiovanni LG. Clinical utility of ictal eyes closure in the differential diagnosis between epileptic seizures and psychogenic events. Epilepsy Res. 2013;104(1-2):1–10. https://doi.org/10.1016/j.eplepsyres.2012.12.004.
15. Brigo F, Igwe SC, Erro R, et al. Postictal serum creatine kinase for the differential diagnosis of epileptic seizures and psychogenic non-epileptic seizures: a systematic review. J Neurol. 2015;262(2):251–7. https://doi.org/10.1007/s00415-014-7369-9.
16. Brigo F, Nardone R, Ausserer H, et al. THe diagnostic value of urinary incontinence in the differential diagnosis of seizures. Seizure. 2013;22(2):85–90. https://doi.org/10.1016/j.seizure.2012.10.011.
17. Brigo F, Nardone R, Bongiovanni LG. Value of tongue biting in the differential diagnosis between epileptic seizures and syncope. Seizure. 2012;21(8):568–572. https://doi.org/10.1016/j.seizure.2012.06.005.
18. Brigo F, Storti M, Lochner P, et al. Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. Epilepsy Behav EB. 2012;25(2):251–5. https://doi.org/10.1016/j.yebeh.2012.06.020.
19. Cornaggia CM, Beghi M, Beghi E. Why talking about psychiatric comorbidity in PNES? Epilepsy Behav. 2017;75:276. https://doi.org/10.1016/j.yebeh.2017.07.010
20. Direk N, Kulaksizoglu IB, Alpay K, Gurses C. Using personality disorders to distinguish between patients with psychogenic nonepileptic seizures and those with epileptic seizures. Epilepsy Behav. 2012;23:138–141. https://doi.org/10.1016/j.yebeh.2011.11.013.
21. Gilmour GS, MacIsaac R, Subotic A, Wiebe S, Josephson CB. Diagnostic accuracy of clinical signs and symptoms for psychogenic nonepileptic attacks versus epileptic seizures: A systematic review and meta-analysis. Epilepsy Behav. 2021;121(Pt A):108030. https://doi.org/10.1016/j.yebeh.2021.108030.
22. Izadyar S, Shah V, James B. Comparison of postictal semiology and behavior in psychogenic nonepileptic and epileptic seizures. Epilepsy Behav. 2018;88:123–129.
23. Jayne M, Jennifer P, Marson AG. Psychological and behavioural treatments for adults with non-epileptic attack disorder. Cochrane Database Syst Rev 2014. https://doi.org/10.1002/14651858.CD006370.pub2.
24. Jones LL, Rickards H. History of abuse and psychogenic nonepileptic seizures: A systematic review. Seizure. 2021;92:200-204. https://doi.org/10.1016/j.seizure.2021.09.009.
25. Josephson CB, Sandy S, Jette N, Sajobi TT, Marshall D, Wiebe S. A systematic review of clinical decision rules for epilepsy. Epilepsy Behav. 2016;57:69–76. https://doi.org/10.1016/j.yebeh.2016.01.019.
26. Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS. A prospective evaluation and follow-up of patients with syncope. N Engl J Med. 1983;309(4):197–204. https://doi.org/10.1056/NEJM198307283090401
27. Kunze A, Reuber M. THe first seizure as an indicator of epilepsy. Curr Opin Neurol. 2018;31(2):156-161. https://doi.org/10.1097/WCO.0000000000000529.
28. LaFrance WC Jr, Baker GA, Duncan R, Goldstein LH, Reuber M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia. 2013;54(11):2005-18. https://doi.org/10.1111/epi.12356. PMID:
29. NICE. CG109: transient Loss of Consciousness (’blackouts’) in over 16s. National Institute for Health and Clinical Excellence [nice.org.uk]. nice. org; 2010 [updated 1 September 2014]. Avaliable: https://www.nice.org.uk/guidance/cg109/.
30. O’Callaghan P. Transient loss of consciousness. Medicine (Baltimore) 2012;40(8):427–30. https://doi.org/10.1016/j.mpmed.2012.05.010.
31. Patel J, Tran QK, Martinez S, Wright H, Pourmand A. Utility of serum lactate on differential diagnosis of seizure-like activity: A systematic review and meta-analysis. Seizure. 2022;102:134-142. https://doi.org/10.1016/j.seizure.2022.10.007.
32. Petkar S, Cooper P, Fitzpatrick AP. How to avoid a misdiagnosis in patients presenting with transient loss of consciousness. Postgrad Med J. 2006;82(972):630–41. https://doi.org/10.1136/pgmj.2006.046565
33. Reuber M, Baker GA, Gill R, Smith DF, Chadwick DW. Failure to recognize psychogenic nonepileptic seizures may cause death. Neurology. 2004;62(5):834–835. https://doi.org/10.1212/01.WNL.0000113755.11398.90.
34. Reuber M, Chen M, Jamnadas-Khoda J, et al. Value of patient-reported symptoms in the diagnosis of transient loss of consciousness. Neurology. 2016;87(6):625–633. https://doi.org/10.1212/WNL.0000000000002948.
35. Rugg-Gunn FJ, Harrison NA, Duncan JS. Evaluation of the accuracy of seizure descriptions by the relatives of patients with epilepsy. Epilepsy Res. 2001;43(3):193–199. https://doi.org/10.1016/S0920-1211%2800%2900209-6.
36. Salinsky M, Evrard C, Storzbach D, Pugh MJ. Psychiatric comorbidity in veterans with psychogenic seizures. Epilepsy Behav. 2012;25:345–349. https://doi.org/10.1016/j.yebeh.2012.07.013.
37. Stiell IG, Bennett C. Implementation of clinical decision rules in the emergency department. Acad Emerg Med. 2007;14(11):955–9. https://doi.org/10.1111/j.1553-2712.2007.tb02372.x.
38. Sundararajan T, Tesar GE, Jimenez XF. Biomarkers in the diagnosis and study of psychogenic nonepileptic seizures: a systematic review. Seizure. 2016;35:11–22. https://doi.org/10.1016/j.seizure.2015.12.011.
39. Syed TU, LaFrance WC, Kahriman ES, et al. Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol. 2011;69(6):997–1004. https://doi.org/10.1002/ana.22345.
40. Wardrope A, Newberry E, Reuber M. Diagnostic criteria to aid the differential diagnosis of patients presenting with transient loss of consciousness: A systematic review. Seizure. 2018;61:139-148. https://doi.org/10.1016/j.seizure.2018.08.012.
41. Zaidi A, Clough P, Cooper P, Scheepers B, Fitzpatrick AP. Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause. J Am Coll Cardiol. 2000;36(1):181–184.
Review
For citations:
Petrova N.N., Semenova N.V. Transitional loss of consciousness as an interdisciplinary problem of diagnosis. V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY. 2023;57(3):30-40. (In Russ.) https://doi.org/10.31363/2313-7053-2023-812
Views:
392
Email this article 