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Response II

Robert S. Fisher, MD, PhD

Arch Neurol. 1987;44(11):1189-1190.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Medicine comprises the art of treating in the face of uncertainty. On many occasions, patients present their doctors with diagnostic dilemmas regarding their "spells." Such episodes may represent seizures, transient ischemic attacks, atypical migraine, syncope, presyncope, cardiac irregularities, sleep disorders, inter-mittent movement disorders, fluctuating metabolic encephalopathies, and a host of psychological or psychiatric entities including hyperventilation spells, panic attacks, conversion reactions, or malingering. Rarely is the physician afforded the opportunity personally to witness a spell, or, alternatively, to talk to fully qualified dispassionate observers.

In some instances, a patient expresses concern about whether his or her condition is "epilepsy," but more often the patient simply wants to know if he or she has anything serious, and whether treatment is required. The most legitimate start of a physician's answer to these queries is the phrase: "Chances are...." I have many times told patients that they might have had a . . . [Full Text PDF of this Article]

Author Affiliations
From the Department of Neurology, The Johns Hopkins Hospital, Baltimore.

Footnotes
Accepted for publication June 15, 1987.

Reprint requests to Department of Neurology, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205 (Dr Fisher).

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