Table 1 Patients’ data
Pt. no./age at diagnosis | 1/40–54y a | 2/19–24y a | 3/ >55y a | 4/19–24y a | 5/ >55y a | 6/ >55y a | 7/ >55y a |
|---|---|---|---|---|---|---|---|
History of other medical issues/medications | Healthy/ none | Healthy/ none | GERD, migraines/ omeprazole | Type 1 DM/ insulin, OXC | Osteoporosis/ alendronate, omeprazole, OXC, TPM, CBZ | HTN, DM, obesity/ ramipril, lercanidipine, metformine, simvastatin | Cognitive & behavioral impairment/ haloperidol, CBZ, TPM |
TLOC onset (age)/CA or IA | <18ya/CA | 19–24ya/CA | >55ya/CA | 19–24ya/IA | 25–39ya/IA | >55ya/IA | <18ya/probable IA |
Clinical manifestations of events | Unconscious fall preceded by disorientation, rapid recovery | General weakness sometimes followed by unconscious fall, with rapid recovery and residual transient left extremities weakness | Abdominal discomfort, dizziness, sometimes followed by general weakness and unconscious fall, rapid recovery | Scenes from the past, thoughts and emotions, in a brief run; after 1y unconscious falls, sometimes preceded by same feelings | Loss of contact, sometimes preceded by general weakness and sometimes followed by unconscious fall, prolonged recovery. In the past – GTCSs. | Unconscious after GTCS followed by right Todd’s palsy, multiple TLOC events with cyanosis, some evolving after right sided convulsions | Loss of contact, oral and right arm automatisms, sometimes followed by bilateral convulsions. Episodes of gait instability sometimes followed by falls. |
Frequency of events | Many/day every few months to years | Weakness-once/week, fall-once/2 weeks | Preceding symptoms-once/3–4 weeks, fall-once/ 2 months | Monthly | Falls-twice a week, daily contact loss | Acute on presentation to ER, 1–5/h for several hours | Daily |
ECG findings/longest asystole duration/captured by | complete AV block/ 25 s/ VEEG for characterization of events | complete AV block/ 4.5 s/ Holter ECG | complete AV block/7 s/ ECG loop recorder | bradycardia evolving into asystole/ 22 s/ VEEG for characterization of events | bradycardia evolving into asystole/ 15 s/ VEEG for DRE | bradycardia evolving into asystole/ 10 s/ ECG monitor | bradycardia evolving into asystole/56 s/VEEG for DRE |
EEG findings | Normal between episodes, generalized slowing and background attenuation during asystole | Normal (awake & sleep deprived) | Normal (awake & sleep deprived) | Left temporal ictal activity, independent left and right temporo-occipital interictal activity | Left temporal ictal and interictal epileptic activity | Left temporal periodic epileptiform discharges | Slow background, right and left fronto-temporal independent interictal activity, right temporal ictal activity |
Imaging | Normal (CT) | Normal (MRI) | Normal (MRI) | Normal (MRI) | Left temporal AVM (MRI, angiography) | Left temporal ICH (CT, MRI) | Left MTS, right hippocampal atrophy, white matter microvascular changes, general atrophy (MRI) |
Duration of follow-up after pacemaker implantation/outcome | 1y/ no TLOC, anxiety developed, off medications | 2y/ 1 TLOC during stress, M/P reflex syncope | 4 m/ no events | 8y/free of all events, on LTG | 2y/falls decreased to once/1–2 m, on OXC, TPM, CBZ | 1y/ PAF, no seizures or TLOC events, on VPA | No implantation/daily events continue |