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THE UNREAL WORLD

Confused? So are the 'GH' docs

August 25, 2008|Marc Siegel | Special to The Times

"General Hospital: Night Shift," "We'll Always Have Paris," SOAPNet, Aug. 12.

The premise: A young woman, Danielle, comes to the ER speaking French. She appears to recognize Dr. Patrick Drake (Jason Thompson) as her former boyfriend "Jean" who jilted her. In the examination room, Danielle suddenly speaks English and admits she's from Maryland, but she still thinks she is at a bank in France rather than at an American hospital. She later loses her hearing, becomes frantic and blacks out. The doctors review Danielle's MRI and decide she has Susac's syndrome, a rare brain disorder that causes confusion, and which the "GH" doctors say makes you think you are living in the past. Drake starts her on intravenous steroid treatments; she rapidly improves.

The medical questions: Is Susac's syndrome a real condition? Are its symptoms and treatments depicted correctly?

The reality: Susac's syndrome is a real condition, first described by neurologist John O. Susac in 1979. "It is characterized by encephalopathy [brain swelling] with bizarre behavior, memory loss and lesions to the white matter of the brain," says Dr. Gary Abrams, associate professor of neurology at UC San Francisco and rehabilitation section chief at the San Francisco VA Medical Center. Susac's syndrome also involves damage to the tiny retinal arteries in the eyes as well as the inner ear, and can include sudden hearing loss as well as confusion, though generally not blackouts.

Abrams says that Susac's syndrome "would be a reasonable explanation that is at least in the ballpark" for Danielle's condition, but Dr. Orrin Devinsky, professor of neurology at the New York University School of Medicine and director of the university's epilepsy center, disagrees. "The show combines elements of several psychiatric and neurological disorders that almost never appear together," he says. "The idea of living in the past is pure TV drama."

Devinsky says that losing awareness of one's identity and where one is located is more characteristic of an altered state of consciousness known as a fugue state. And Fregoli syndrome (due to schizophrenia, dementia, brain degeneration or injury) is more likely to make a patient suffer a delusional belief that strangers are familiar. Devinsky says that patients with strokes or head injury may sometimes revert to the language of their childhood -- but they stay with it, and don't go back and forth the way the show depicts. Patients can also sometimes begin to speak in a foreign accent -- foreign accent syndrome -- usually after a small stroke or head injury to the left frontal part of the brain.

Susac's syndrome can improve spontaneously and has been found to respond to steroids and immunosuppressive drugs. "Susac's is probably an autoimmune disorder," Abrams says, "so the treatment with steroids to treat inflammation makes sense."

What doesn't make sense -- except in a soap opera -- is the hodgepodge of dramatic symptoms imported from other conditions.

Dr. Marc Siegel is an internist and an associate professor of medicine at New York University's School of Medicine. In The Unreal World, he explains the medical facts behind the media fiction. He can be reached at marc@doctorsiegel.com.

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