By M.J.G. Harrison (Eds.)
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Additional resources for Contemporary Neurology
At present the studies' main function, apart from research, is usually to look for some objective evidence of sinus node or conducting system abnormality in patients with persisting symptoms who have had several nondiagnostic periods of ambulatory monitoring. In contrast to the situation in chronic complete heart block, there is little evidence that the sick sinus syndrome reduces life expectancy (Shaw et al, 1980). Pacemaker implantation is usually very effective in controlling symptoms, either on its own or, in patients with the tachycardia-bradycardia syndrome, in conjunction with antiarrhythmic drugs.
These may be difficult to diagnose, particularly since some patients with true epileptic seizures also have hysteroid attacks. Many such patients show hysterical features and are immature and dependent with a past or family history of psychiatric illness. The attacks themselves are often bizarre with marked opisthotonos and forceful movements. The severity of the latter may appear proportional to the degree of restraint. Incontinence and tongue biting do not occur. The plantar responses remain flexor.
Commonly there is transient loss of consciousness or awareness. Gowers (1901) described 155 such patients. In nearly one third there was sudden falling with loss of consciousness of brief duration but no convulsive features. Nearly one third had sensations suggestive of brief auras common to partial complex seizures, 16 per cent complained of giddiness, and 11 per cent experienced jerks or starts in the limbs. Some of these attacks would now be labelled drop attacks or myoclonic jerks. Myoclonic jerks or starts may herald a more major attack or arise alone, often shortly after waking.
Contemporary Neurology by M.J.G. Harrison (Eds.)