From the Guidelines
Drop attacks are a non-specific descriptor of sudden falls without clear warning signs or symptoms, and should be classified as unexplained or non-accidental falls rather than a distinct diagnosis. According to the 2018 ESC guidelines for the diagnosis and management of syncope, as described in the European Heart Journal 1, the term 'drop attacks' may be used to describe sudden falls occurring without an obvious external cause, but it does not imply a specific cause.
Key Characteristics of Drop Attacks
- Sudden falls without clear warning signs or symptoms
- No awareness of loss of consciousness (LOC)
- Should be classified as unexplained or non-accidental falls
- May be used to describe atonic seizures in epilepsy, sudden falls without vertigo in Ménière's disease, or a specific syndrome in middle-aged and elderly women
Diagnosis and Treatment
- Diagnosis involves a thorough medical history, physical examination, and possibly tests like EEG, MRI, or cardiac monitoring to determine the underlying cause
- Treatment depends on identifying the underlying cause, such as medication for Ménière's disease, anti-seizure drugs for epilepsy, or pacemakers for cardiac issues
- Safety measures are important for those experiencing drop attacks, including avoiding heights, using walking aids, and wearing protective gear to prevent injury during falls, as noted in the context of the 2018 ESC guidelines 1.
From the Research
Definition and Causes of Drop Attacks
- Drop attacks encompass both falls and transient loss of consciousness, but the term is not clearly defined 2
- The most common causes of drop attacks are cardiovascular, with vestibular dysfunction also being a common cause, especially in the elderly 2
- Other potential causes of drop attacks include epilepsy, functional neurological disorder, cataplexy, and hydrocephalic attacks 2
Epileptic Drop Attacks
- Epileptic drop attacks are a type of seizure that can cause sudden falls, and are often refractory to treatment 3
- A combination of valproate, lamotrigine, and a benzodiazepine may be effective in reducing the frequency of epileptic drop attacks 3
- Epileptic drop attacks are often associated with developmental delay and learning difficulties, and may be related to a lesion in the frontal lobe 4
- The prognosis for patients with epileptic drop attacks is often poor, with many experiencing ongoing seizures and mental deterioration 5
Diagnosis and Investigation
- Diagnosis of drop attacks can be challenging, and may require investigation for underlying cardiac or neurological conditions 2, 6
- Clinical and electrographic criteria can suggest underlying arrhythmia or other serious cardiac disorders that require further investigation 2
- Video-EEG monitoring can be useful in diagnosing and characterizing seizures presenting with falls or atonic seizures 4