Seizure

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*

• memory gaps
• confusional spells
• staring spells
• episodic irritability
• episodic tinitis
• episodic aphasia
• jamais vu
• olfactory hallucinations
• gustatory hallucinations
• visual illusions (e.g., scintillations)
• paresthesias
• anesthesias
• auditory illusions (e.g., phone ringing) headache with
• nausea and/or photophobia abrupt mood shifts
• deja vu
• "odd" abdominal sensations
• intrusive thoughts
• parasomnias

* = list not at all comprehensive for Sx of ESD

It is not necessary to have a loss of consciousness to suffer permanent brain injury.

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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