Paroxysmal Disorders

Paroxysmal Disorders

Paroxysmal disorders are disorders that occur unexpectedly. Examples of this include intermittent room spinning dizziness, intermittent swaying sensations, collapses, and seizures. These can be unpredictable and lead to falls and subsequent injuries. Depending on the specific condition, some of these disorders are treated with simple bedside manoeuvres whilst others require further investigations and treatment with medications. In some cases, rehabilitation is indicated to develop compensatory strategies to enable one to return to their previous level of function before the onset of their problem.


Headaches are a common problem experienced by many people. The overall headache prevalence rates vary between 29 and 77% in adults. The World Health Organization ranks headache disorders as among the top 10 most disabling conditions for men and women, and into the five most disabling disorders for women.
Most headaches are managed with simple measures, ranging from avoidance of certain triggers to the use of pain killers such as paracetamol or ibuprofen. This is usually adequate for the majority of people, especially when these occur episodically, such as once every few months.Unfortunately, due to various

biopsychosocial factors, headaches may become chronic and not responsive to these simple measures, subsequently affecting one’s quality of life and contributing to lower productivity. Treatment may range from identification of specific triggers and lifestyle modification, to the use of preventer medications, injectable therapies or external neurostimulation.
If you have been previously treated with 3 migraine preventers in the past and continue to experience more than 15 headaches per month, of which 8-9 are migraines, you may meet the PBS criteria for botulinum toxin injections for chronic migraine.


Epilepsy is a condition where one has a predisposition for unprovoked seizures that are unpredictable in frequency. It is a common and complex neurological disorder affecting people of all ages, with approximately 50 million people affected worldwide. The frequency of seizures may range from only once in a person’s lifetime to several times per month, to several times per day. Effective treatment is available, and approximately 70% of people respond to treatment.

The prevalence of active epilepsy ranges between 6.2 to 7.6 per 1000 population. Epilepsy accounts for 0.75% of the global burden of disease and is responsible for approximately 20.6 million disability-adjusted life years (DALYs) lost.
The cause of epilepsy is often multifactorial ranging from genetic and environmental factors, to autoimmune. One seizure does not mean a diagnosis of epilepsy, as up to 10% of people worldwide will have one seizure during their lifetime.


Syncope is a common presenting complaint and generally means a sudden loss of consciousness due to global cerebral hypo-perfusion. It is a common manifestation of several diverse disorders that span multiple medical specialties and is frequently complicated by injuries, largely due to the loss of one’s protective reflexes on falling.

Determining the underlying cause is often challenging and it can be precipitated by exertion, stress, meals, alcohol, drugs, cough, swallowing, urination, and postural changes. It can sometimes lead to limb movements, making it difficult to distinguish from epilepsy. Syncope is a common medical problem with a lifetime prevalence of approximately 42% and an annual incidence of 6%.