Source: Definition of Mild Traumatic Brain Injury Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine.
J Head Trauma Rehabil 1993:8(3):86-87
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Clinical presentation of ESD patients
The core symptoms which characterized Tucker's patients included: a) "spells" or periods in which the patient reports losing track of time, staring, feeling as if they were in a trance; b) intense, unprecipitated episodic affective disturbances involving feelings of anxiety, depression, or rage which remit suddenly; c) episodic cognitive disturbances, including problems with speech articulation, confusion, feelings of jamais vu or deja vu, and paranoid ideation; f) episodic olfactory, gustatory, visual, haptic, and/or auditory hallucinations/illusions; and e) suicidal ideation and/or a history of previous suicide attempts. It is important to emphasize both the episodic nature of these symptoms within the context of normal functioning between episodes and the absence of clearly epileptiform findings in the patients' EEG records.
The typical ESD patient is likely to have acquired his or her disorder as a result of head injury, hypoxia, brain disease or other CNS disorder. The patient is likely to have a long, confusing history characterized by multiple diagnoses and unsuccessful treatment of symptoms. In addition, many ESD patients fail to spontaneously report a sufficient number of symptoms to support a diagnosis and are not identified except through interview of patients who are at risk of developing the disorder (e.g., head injury) or who make a partial report of symptoms. Thus, ESD has proven to be a relatively common clinical phenomenon among those at risk, particularly the head injured, when diagnostic work-ups include screening for the disorder.
The most effective and most direct means to diagnose ESD is to determine what symptoms the patient has and how frequently they occur. This can be done with the standardized assessment procedure developed by Roberts in which patients are interviewed for 36 behavioral symptoms typically associated with partial seizures (Roberts et al. 1989). These neurobehavioral symptoms were first identified by Hughlings Jackson and are still commonly employed in the diagnosis of CPSz today (Daly 1982). This interview requires the patient to rate both presence and frequency of symptoms, yields a total score-measuring number and frequency of symptoms, and has norms for frequency of each symptom as well as total score. Patients with many frequently occurring symptoms are likely to have ESD and differ significantly from controls and patients with classic CPSz (Roberts et al. 1990). A list of some target ESD symptoms is shown in Table 1.
TABLE 1. Some neurobehavioral symptoms of ESD*
*=list not at all comprehensive for Sx of ESD
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Additional Information
For a full treatment of the topic of brain injury, and recovering adequate compensation for those who have survived such injury, please visit our other pages. tbilaw.com A general treatment of all types of brain injury, including severe brain injury and concussion, with a special focus on the legal aspects of recovering full and adequate compensation for such injuries. tbilaw.com has been at the cornerstone of the web advocacy of the Brain Injury Law Group since it went online in 1996. waiting.com A page designed to assist those with issues regarding coma, especially in the acute phase when the doctors are saying "I just don't know." vestibulardisorder.com Addressing vertigo and dizziness resulting from trauma as well as information and resources for vestibular disorders.
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