Posttraumatic Seizures in Survivors of Torture: Manifestations, Diagnosis, and Treatment

Springer Science and Business Media LLC - Tập 6 - Trang 179-186 - 2004
Alejandro Moreno1,2,3, Michael Peel4
1The Austin Medical Education Programs at Brackenridge Hospital, Austin
2The Boston Center for Refugee Health and Human Rights at Boston Medical Center, Boston
3The Health Law Department, Boston University School of Public Health, Boston
4The Medical Foundation for the Care of Victims of Torture, London, United Kingdom

Tóm tắt

Survivors of torture are very likely to have been beaten repeatedly around the head. Apparent brief losses of consciousness are not uncommon following torture, and they may be associated with signs that suggest temporal lobe epilepsy (TLE). The relative risk of developing posttraumatic seizures (PTS) is increased by about 50% after a single head injury involving a brief loss of consciousness. It is 2.9 if that loss of consciousness lasts for more than about 30 min. Thus, patients who have been tortured are at increased risk of seizures. TLE is difficult to diagnose and needs specialist investigations, and other conditions that are not uncommon in survivors of torture, such as panic attacks, posttraumatic stress disorder, dissociation, and syncope can all present with similar pictures. This paper addresses the differential diagnosis of posttraumatic epilepsy in survivors of torture.

Tài liệu tham khảo

Moreno A, Grodin MA: Torture and its neurological sequelae. Spinal Cord 2002; 40:213–223 Rasmussen O: Medical aspects of torture. Danish Med Bull 1990; 37(Suppl 1):1-88 Begovac J, Jeren T, Kuzman I, Jukic V, Ravlic Z, Andrasevic S: Health status of 1458 Croatian prisoners of war, 1991-1992. JAMA 1993; 270:574–575 United Nations High Commissioner for Refugees: 2001UN-HCR population statistics (Provisional). Retrieved July 14, 2003, from http://www.unhcr.ch/cgi-bin/texis/vtx/statistics United Nations High Commissioner for Refugees: Asylum trends in industrialized countries, May 2003. Retrieved July 14, 2003, from http://www.unhcr.ch/cgi-bin/texis/vtx/ statistics Brenner J: Human rights education in public health graduate schools: 1996 survey. Health Human Rights 1996; 2(1):129–139 Rafuse J: Multicultural medicine: "Dealing with a population you weren't quite prepared for." Can Med Assoc J 1993; 148(2):282–285 Sonis J, Gorenflo DW, Jha P, Williams C: Teaching human rights in US medical schools. JAMA 1996; 276(20):1670–1678 Ko DY, Sahai S: Temporal lobe epilepsy. E-Medicine. October 19, 2001. Retrieved July 1, 2003, from www. emedicine.com/NEURO/topic365.htm Chadwick D: Seizures and epilepsy after traumatic brain injury. Lancet 2000; 355:334–335 Sawhney IMS, Singh A, Kaur P, Suri G, Chopra JS: A case control study and one year follow-up of registered epilepsy cases in a resettlement colony of North India, a developing tropical country. J Neurol Sci 1999; 165:31–35 Valencia M, Valencia P: Etiology of the epileptic seizures in Recife City, Brazil: Study of 249 patients. Arquivos de Neuro-Psiquiatria 2000; 58:1064–1072 Brain Injury Special Interest Group-American Academy of Physical Medicine and Rehabilitation: Practice parameter: Antiepileptic drug treatment of posttraumatic seizures. Arch Phys Med Rehabil 1998; 79:594–597 Dugan EM, Howell JM: Posttraumatic seizures. Emerg Med Clin North Am 1994; 12(4):1081–1087 Iudice A, Murri L: Pharmacological prophylaxis of posttramatic epilepsy. Drugs 2000; 59:1091–1099 Willmore JL: Posttraumatic seizures. Neurol Clin 1993; 11(4):823–834 Annegers JF, Hauser WA, Coan SP, Rocca WA: A population-based study of seizures after traumatic brain injuries. NEJM 1998; 338:20–24 Riquelme HU: EsLa practica de la medicina bajo la influencia de la dominacion totalitaria. Entre la obediencia y la oposicion-Los medicos y la etica profesional bajo la dictadura. Caracas: Editorial Nueva Sociedad; 1995:43–145 Wheless JW, Kim HL: Adolescent seizures and epilepsy syndromes. Epilepsia 2002; 43(Suppl 3):33–52 Ahern GL, Howard GF, Weiss KL: Posttraumatic pilo-motor seizures: A case report. Epilepsia 1998; 29(5):640–643 Blumer D: Evidence supporting the temporal lobe epilepsy personality syndrome. Neurology 1999; 53(5):S9–S12 Devinsky O, Naijar S: Evidence against the existence of a temporal lobe epilepsy personality syndrome. Neurology 1999; 53(5):S13–S25 Alemayehu S, Bergey GK, Barry E, Krumholz A, Wolf A, Fleming CP, Frear EJ: Panic attacks as ictal manifestation of parietal lobe seizures. Epilepsia 1995; 36:824–830 Chadwick D: Not everything that jerks is epilepsy. Br J Sports 1997; 31:173 Stephenson JB: Fits and Faints. Oxford: MacKeith Press; 1990:41–42 McCrory PR, Berkovic SF: Concussive convulsions-Incidence in sport and treatment recommendations. Sports Med 1998; 25(2):131–136 Foster DW, Rubenstein AH: Hypoglycemia: In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL, eds. Harrison's Principles of Internal Medicine, 13 edn. New York: McGraw-Hill; 2000:2006 Chadwick D, Smith D: The misdiagnosis of epilepsy. BMJ 2002; 324:495–496 Rosenberg HJ, Rosenberg SD, Williamson PD, Wolford GL: A comparative study of trauma and posttraumatic stress disorder prevalences in epilepsy patients and psychogenic nonepileptic patients. Epilepsia 2000; 41:337–452 Fleisher W, Staley D, Krawetz P, Pillay N, Arnett JL, Maher J: Comparative study of trauma-related phenomena in subjects with pseudoseizures and subjects with epilepsy. Am J Psychiatry 2002; 159:660–663 Sackarelles DK, Sackarelles JC: Impaired motor function in patients with pseudoseizures. Epilepsia 2001; 42:1600–1606 Coons PM: The dissociative disorders, rarely considered and underdiagnosed. Psychiatr Clin North Am 1998; 21:637–648 Kuyk J, Spinhoven P, van Emde Boas W, van Dyck R: Dissociation in temporal lobe epilepsy and pseudo-epileptic seizure patients. J Nerv Ment Dis 1999; 187:713–720 Jacobs UVI: Torture and its consequences: A challenge to clinical neuropsychology. Prof Psychol Res Pract 2001; 32(5):458–464 Moreno A, Grodin MA: The not-so-silent marks of torture. JAMA 2000; 284(5):538 Physicians' Desk Reference, 57th edn. Montvale, NJ: Medical Economics Company; 2003 Patsalides BH, Moreno A, Liebschutz JM: Immigrants, refugees, and survivors of torture: In: Liebschutz JM, Frayne SM, Saxe GN, eds. Violence Against Women-A Physician's Guide to Identification and Management. Philadelphia, PA: American College of Physicians; 2003:225–250 American Psychiatric Association: Outline for cultural formulation and glossary of culture-bound syndromes: In: Di-agnostic Statistical Manual of Mental Disorders (DSM IV-TR). Washington, DC: American Psychiatric Association; 2000:897–903 Epilepsy Foundation: Driver Information by State. Retrieved July 01, 2002, from http://www.epilepsyfoundation.org/ answerplace/Social/driving/statedrivinglaws.cfm Kitson A, Shorvon S: Clinical Standards Advisory Group. Services for Patients With Epilepsy. London, UK: Department of Public Health; 2000 Pedley TA: The epilepsies: In: Goldman L, Bennett JC, eds. Cecil Textbook of Medicine, 21st edn. Philadelphia, PA: WB Saunders; 2000:2151–2163 Wieshmann UC, Free SL, Everitt AD, Barlett PA, Barker EJ, Tofts PS: Magnetic resonance imaging in epilepsy with a fast FLAIR sequence. J Neurol Neursurg Psychiatry 1996; 61(4):357–361 Jack CR, Rydberg CH, Krecke KN: Mesial temporal sclerosis: Diagnosis with fluid attenuated inversion-recovery versus spin-echo MRI imaging. Radiology 1996; 2:367–373 Thompson SA, Duncan JS, Smith SJ: Partial seizures presenting as panic attacks. BMJ 2000; 321:1002–1003 Pataraia E, Lindinger G, Deecke L, Baumgartner C: MEG evaluation in temporal lobe epilepsy. Retrieved from July 01, 2003, from 'www.ctf.com/papers/pataraia Biomag00 1.pdf <http://www.ctf.com/papers/pataraia Biomag'00 1.pdf>. Hernandez TD, Naritoku DK: Seizures, epilepsy, and functional recovery after traumatic brain injury: A reappraisal. Neurology 1997; 48:803–806 Chatham-Showalker PE, Kimmel DN: Stimulating consciousness and cognition following severe brain injury: A new potential clinical use for lamotrigine. Brain Injury 2000; 14(11):997–1001 Iacopino V, Ozkalipci O, Schlar C: The manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment (the Istanbul Protocol). Retrieved from http://www.unhchr.ch/html/menu6/2/training.htm Teasdale G, Jennett B: Assessment of coma and impaired consciousness: A practical scale. Lancet 1974; 2:81–84