Drop attacks- a shove to the ground by the invisible hand

Have you ever been shoved to the ground by the invisible hand ? If so, you may be suffering from drop attacks. A drop attack is a very distressing and potentially serious occurrence during which a patient suddenly falls to the ground.

Drop attacks
Drop attacks may occur in Meniere’s disease

It occurs spontaneously, and without warning. Patients are fully aware of what is happening, and no loss of consciousness occurs. Although episodes only last seconds to minutes it is not uncommon to sustain injuries. After the fall the patient will typically be able to stand up and walk on, as if nothing has happened. Unfortunately, the converse may also be true.

Drop attacks may occur due to several conditions, including cardiovascular and neurological problems such as seizures. The exact cause may not always be obvious and is most often unknown. It may be psychological. When drop attacks occur due to an inner ear problem such as Meniere’s disease (MD) it is also referred to as an “Otolithic crisis of Tumarkin”. The sudden trigger of the hair cells in the otolithic organs, especially the saccule, leads to the sudden loss of balance. Fortunately drop attacks are rare in MD, occurring in about 5% of patients. Drop attacks are more common in females.

In a patient that presents with drop attacks, cardiovascular and neurological examination including electroenchepalogram (EEG) will most likely be required.  Videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP), diagnostic audiometry and electrocochleography (ECOG) help in diagnosing MD. A magnetic resonance image (MRI) of the brain will most likely be requested to exclude neurological conditions that may lead to drop attacks.

Treatment of drop attacks in MD is not straight forward and most medication is ineffective. Unfortunately, surgical or medical (gentamicin) destruction of the labyrinth is usually required. In some patients a selective vestibular nerve section offers the possibility to preserve hearing. During this surgical procedure the vestibular (balance) part of the nerve is selectively cut to prevent further drop attacks. The auditory (hearing) part and thus the hearing is preserved in this way. It also offers the possibility for cochlear implantation (CI) if later required.