Fits, faints, and funny turns (FFFTs)--a potpourri

Hindley D, Ali A, Robson C. Diagnoses made in a secondary care "fits, faints, and funny turns" clinic. Arch Dis Child. 2006 Mar;91(3):214-8.

Abstract

AIMS:

To investigate the diagnoses made for children referred to a "fits, faints, and funny turns" clinic.

METHODS:

Prospective study of 380 children referred to a dedicated secondary care clinic over an eight year period.

RESULTS:

Twenty three per cent of children were given a final diagnosis of one of the childhood epilepsies, with 48% of these having a specific epilepsy syndrome. Syncope was the commonest cause of a non-epileptic event (syncope and reflex anoxic seizures comprised 100/238, 42%) but there were a wide variety of other causes. Fifty three events (14%) were unclassified and managed without a diagnostic label or treatment.

CONCLUSIONS:

In children with funny turns referred to secondary care, the diagnostic possibilities are numerous; among non-epileptic events, syncopes predominate. The majority do not have epilepsy. Unclassifiable events with no clear epileptic or non-epileptic cause are common and can be safely managed expectantly.

Thijs RD, Bloem BR, van Dijk JG. Falls, faints, fits and funny turns. J Neurol. 2009 Feb;256(2):155-67.

Abstract

In this practically oriented review, we will outline the clinical approach of patients with falls due to an impairment or loss of consciousness. Following a set of definitions, we describe the salient clinical features of disorders leading to such falls. Among falls caused by true loss of consciousness, we separate the clinical characteristics of syncopal falls (due to reflex syncope, hypovolemia, orthostatic hypotension or cardiac syncope) from falls due to other causes of transient unconsciousness, such as seizures. With respect to falls caused by an apparent loss of consciousness, we discuss the presentation of cataplexy, drop attacks, and psychogenic falls. Particular emphasis will be laid upon crucial features obtained by history taking for distinguishing between the various conditions that cause or mimic a transient loss of consciousness.

Mackay M. Fits, faints and funny turns in children. Aust Fam Physician. 2005 Dec;34(12):1003-8.

Abstract

BACKGROUND:

Seizures and epilepsy are a common problem in childhood. There are many other paroxysmal disorders that can mimic seizures and it is important to exclude these conditions before diagnosing epilepsy and making the decision to commence anticonvulsant treatment.

OBJECTIVE:

This article discusses the features that differentiate seizures from nonepileptic events in children and adolescents.

DISCUSSION:

Diagnosis of epileptic seizures is largely dependent on the clinical history. Modes of presentation include collapse, loss of consciousness, staring, altered responsiveness, limb movements and nocturnal events. Electroencephalography is helpful in confirming the diagnosis and differentiating between focal and generalised seizures.

Murtagh J. Fits, faints and funny turns. A general diagnostic approach. Aust Fam Physician. 2003 Apr;32(4):203-6.

Abstract

BACKGROUND:

The patient presenting with a fit, faint or 'funny turn' can present a diagnostic dilemma for the general practitioner.

OBJECTIVE:

This article aims to provide an overview of the diagnostic approach to these 'episodes'.

DISCUSSION:

The key to diagnosis is to elicit a clear history focussing on the lead-up to the episode, a description of what took place and the events that took place after the episode. The patient's feelings, symptoms, circumstances and provocative factors give vital information.

Morgan H, Blashki G. Fits, faints and funny turns. Could it be a mental disorder? Aust Fam Physician. 2003 Apr;32(4):211-3, 216-9.

Abstract

BACKGROUND:

Patients who present to primary care with symptoms of fainting and dizziness, for which there is no adequate physical explanation, are frequently suffering from an undiagnosed psychiatric disorder.

OBJECTIVE:

This article aims to improve the recognition of common mental disorders presenting as 'fits, faints and funny turns' (FFFTs) and to encourage general practitioners to view these disorders as a positive diagnosis in need of treatment.

DISCUSSION:

Psychiatric disorders, particularly panic attacks and depression, are common in the setting of FFFTs and should be a positive diagnosis rather than a diagnosis of exclusion. A detailed description of the episode, with corroborating information from a witness if possible, and psychiatric rating scales can assist in this process. Identifying a physical cause for the episode does not exclude a psychiatric diagnosis and vice versa. Specific psychological and pharmacological therapies are effective for anxiety and depression.