drop attack
{{Short description|Sudden fall without loss of consciousness}}
File:Une_leçon_clinique_à_la_Salpêtrière.jpg
A drop attack is a sudden fall without loss of consciousness. Drop attacks stem from diverse mechanisms, including orthopedic causes (for example, leg weakness and knee instability), hemodynamic causes (for example, transient vertebrobasilar insufficiency, a type of interruption of blood flow to the brain), and neurologic causes (such as epileptic seizures or unstable vestibular function), among other reasons. Those affected typically experience abrupt leg weakness, sometimes after sudden movement of the head. The weakness may persist for hours.
The term "drop attack", also known as "cryptogenic drop attack" or "La maladie des genoux bleus";{{Cite journal |last1=Stevens |first1=D. L. |last2=Matthews |first2=W. B. |date=1973-02-24 |title=Cryptogenic Drop Attacks: An Affliction of Women |url=https://www.bmj.com/content/1/5851/439 |journal=Br Med J |language=en |volume=1 |issue=5851 |pages=439–442 |doi=10.1136/bmj.1.5851.439 |issn=0007-1447 |pmc=1588502 |pmid=4689829}}{{Cite journal |last1=Butsch |first1=Raphael |last2=Schneemann |first2=Markus |date=2014-06-27 |title=Two women with recurrent falls: La maladie des genoux bleus alias cryptogenic drop attacks |url=https://casereports.bmj.com/content/2014/bcr-2013-200855 |journal=Case Reports |language=en |volume=2014 |pages=bcr2013200855 |doi=10.1136/bcr-2013-200855 |issn=1757-790X |pmc=4078483 |pmid=24973344}}{{Cite journal |last1=Revell |first1=Emily R. |last2=Gillespie |first2=David |last3=Morris |first3=Paul G. |last4=Stone |first4=Jon |date=2021-01-01 |title=Drop attacks as a subtype of FND: A cognitive behavioural model using grounded theory |journal=Epilepsy & Behavior Reports |volume=16 |pages=100491 |doi=10.1016/j.ebr.2021.100491 |issn=2589-9864 |pmc=8550987 |pmid=34746733}} is used to categorize otherwise unexplained falls from a wide variety of causes and is considered ambiguous medical terminology; drop attacks are currently reported much less often than in the past, possibly as a result of better diagnostic precision.{{cite journal|last1=Rubenstein|first1=L. Z.|title=Falls in older people: epidemiology, risk factors and strategies for prevention|journal=Age and Ageing|date=1 September 2006|volume=35|issue=Supplement 2|pages=ii37–ii41|doi=10.1093/ageing/afl084|pmid=16926202|doi-access=free}}{{cite journal|last1=Bisdorff|first1=A|last2=Von Brevern|first2=M|last3=Lempert|first3=T|last4=Newman-Toker|first4=DE|title=Classification of vestibular symptoms: towards an international classification of vestibular disorders|journal=Journal of Vestibular Research: Equilibrium & Orientation|date=2009|volume=19|issue=1–2|pages=1–13|doi=10.3233/VES-2009-0343|pmid=19893191|doi-access=free}} By definition, drop attacks exclude syncopal falls (fainting), which involve short loss of consciousness. In neurology, the term "drop attack" is used to describe certain types of seizure which occur in epilepsy.{{cite journal|last1=Zamponi|first1=N.|last2=Passamonti|first2=C.|last3=Cesaroni|first3=E.|last4=Trignani|first4=R.|last5=Rychlicki|first5=F.|title=Effectiveness of vagal nerve stimulation (VNS) in patients with drop-attacks and different epileptic syndromes|journal=Seizure|volume=20|issue=6|pages=468–474|doi=10.1016/j.seizure.2011.02.011|pmid=21396833|year=2011|doi-access=free}}{{cite journal|last1=Abd-El-Barr|first1=Muhammad M.|last2=Joseph|first2=Jacob R.|last3=Schultz|first3=Rebecca|last4=Edmonds|first4=Joseph L.|last5=Wilfong|first5=Angus A.|last6=Yoshor|first6=Daniel|title=Vagus nerve stimulation for drop attacks in a pediatric population|journal=Epilepsy & Behavior|volume=19|issue=3|pages=394–399|doi=10.1016/j.yebeh.2010.06.044|year=2010|pmid=20800554|s2cid=13346234}} Drop attacks that have a vestibular origin within the inner ear may be experienced by some people in the later stages of Ménière's disease (these may be referred to as Tumarkin [drop] attacks, or as Tumarkin's otolithic crisis).{{cite book|last1=Ruckenstein|first1=MJ|last2=Shea|first2=JJ Jr|editor=Harris, JP|title=Meniere's Disease|url=https://books.google.com/books?id=M1tyxfMr4z4C&pg=PA266|year=1999|publisher=Kugler Publications|isbn=978-90-6299-162-4|page=266}}{{cite web|last1=Hayback|first1=PJ|title=Mèniére's Disease|url=http://vestibular.org/menieres-disease|website=vestibular.org|publisher=Vestibular Disorders Association|accessdate=22 September 2015|date=2012-03-06}}
Drop attacks often occur in elderly people; with a majority of documented cases occurring in women.{{Cite journal |last1=Revell |first1=Emily R. |last2=Gillespie |first2=David |last3=Morris |first3=Paul G. |last4=Stone |first4=Jon |date=2021-01-01 |title=Drop attacks as a subtype of FND: A cognitive behavioural model using grounded theory |journal=Epilepsy & Behavior Reports |volume=16 |pages=100491 |doi=10.1016/j.ebr.2021.100491 |issn=2589-9864 |pmc=8550987 |pmid=34746733}}{{Cite journal |last1=Hoeritzauer |first1=Ingrid |last2=Carson |first2=Alan |last3=Stone |first3=Jon |date=2016-12-01 |title="Cryptogenic Drop Attacks" Revisited |url=https://jnnp.bmj.com/content/87/12/e1.180 |journal=Journal of Neurology, Neurosurgery & Psychiatry |language=en |volume=87 |issue=12 |pages=e1 |doi=10.1136/jnnp-2016-315106.45 |issn=0022-3050}}{{Cite journal |last1=Stevens |first1=D. L. |last2=Matthews |first2=W. B. |date=1973-02-24 |title=Cryptogenic Drop Attacks: An Affliction of Women |url=https://www.bmj.com/content/1/5851/439 |journal=Br Med J |language=en |volume=1 |issue=5851 |pages=439–442 |doi=10.1136/bmj.1.5851.439 |issn=0007-1447 |pmc=1588502 |pmid=4689829}}{{Cite journal |last1=Butsch |first1=Raphael |last2=Schneemann |first2=Markus |date=2014-06-27 |title=Two women with recurrent falls: La maladie des genoux bleus alias cryptogenic drop attacks |url=https://casereports.bmj.com/content/2014/bcr-2013-200855 |journal=Case Reports |language=en |volume=2014 |pages=bcr2013200855 |doi=10.1136/bcr-2013-200855 |issn=1757-790X |pmc=4078483 |pmid=24973344}} Falls in older adults happen for many reasons, and the goals of health care include preventing any preventable falls and correctly diagnosing any falls that do happen.