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Factors Associated With Risk of Recurrent Transient Global Amnesia

Educational Objective
To evaluate whether certain physiological, environmental, or other factors increase the risk for recurrence of transient global amnesia.
1 Credit CME
Key Points

Question  Are there physiological, environmental, or other factors that increase risk for recurrence of transient global amnesia?

Findings  In this cohort study of 1044 patients with transient global amnesia, recurrence was associated with earlier age at the time of the initial episode and higher prevalence of both personal and family history of migraine, compared with isolated cases.

Meaning  These findings may help clinicians when counseling patients with transient global amnesia on their risk of recurrent episodes.

Abstract

Importance  Transient global amnesia (TGA) is usually considered a benign event with a low recurrence rate. However, recurrence rates vary considerably among studies and there are no known risk factors for TGA.

Objective  To examine risk factors for the recurrence of TGA.

Design, Setting, and Participants  This retrospective cohort study involved medical record review of patients with isolated or recurrent TGA presenting to the Mayo Clinic in Rochester, Minnesota, between August 1, 1992, and February 28, 2018. A total of 1491 cases were reviewed and 1044 met diagnostic inclusion criteria for TGA, with the remainder excluded owing to indeterminate or alternate diagnoses or limited information available in the medical record.

Exposures  Single vs recurrent episodes of TGA.

Main Outcomes and Measures  Demographics, precipitating factors, migraine history, imaging and electrodiagnostic findings, and family history of TGA were collected. The main outcome measure was TGA recurrence.

Results  Of 1044 included patients, 575 (55.1%) were male, and the mean (SD) age at inclusion was 75.0 (11.5) years. A total of 901 patients (86.3%) had a single episode of TGA and 143 (13.7%) had recurrent episodes of TGA. The 2 groups were similar in age at inclusion, sex, identifiable triggers, and duration of anterograde amnesia. The number of recurrences ranged from 1 to 9, with 137 individuals (95.8%) having 3 or fewer recurrences. The mean (SD) age at first episode of TGA was 65.2 (10.0) years for individuals with a single episode vs 58.8 (10.3) years for those with recurrent episodes (P < .001). There was a personal history of migraine in 180 individuals (20.0%) with a single episode of TGA and 52 individuals (36.4%) with recurrent episodes of TGA (P < .001), and a family history of migraine in 167 individuals (18.5%) with a single episode of TGA and 44 individuals (30.8%) with recurrent episodes of TGA (P = .001). There were no electroencephalographic findings associated with increased risk of TGA recurrence. Acute and subacute temporal lobe abnormalities on results of magnetic resonance imaging were seen rarely and did not require intervention. A family history of TGA was identified in 12 individuals (1.3%) with a single episode of TGA and 4 individuals (2.8%) with recurrent episodes of TGA.

Conclusions and Relevance  This study suggests that, in this large cohort of patients with TGA, recurrent TGA was associated with earlier age at the time of first TGA episode and higher prevalence of both personal and family history of migraine compared with isolated cases. These results can be used to counsel patients about risks of recurrence and may have implications for the understanding of TGA pathophysiology.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: June 5, 2020.

Corresponding Author: Ken A. Morris, MD, PhD, Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (kennethallenmorris@gmail.com).

Published Online: August 31, 2020. doi:10.1001/jamaneurol.2020.2943

Author Contributions: Dr Morris had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Morris.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Morris, Young.

Administrative, technical, or material support: Morris.

Supervision: Rabinstein, Young.

Conflict of Interest Disclosures: None reported.

Meeting Presentation: This study was presented at the Annual Meeting of the American Academy of Neurology; May 6, 2019; Philadelphia, Pennsylvania.

Additional Contributions: Jay Mandrekar, PhD, and Prabin Thapa, MSc, Department of Biomedical Statistics and Informatics, Mayo Clinic, assisted with statistical testing. They were not compensated for their contributions.

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