Transient Global Amnesia Recurrence: Prevalence and Risk Factor Meta-analysis

Abstract

Background and objectives: Transient global amnesia (TGA) is an acute amnestic disorder with unclear pathophysiology. Although considered a benign phenomenon, the possibility of a recurrence is a major concern for the patient. Our objective is to identify the prevalence and risk factors of relapse to help clinicians counsel patients about it.

Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidance, we screened 1,658 studies from MEDLINE, Lilacs, and Embase databases, published from 1985 to April 2021, in English or Spanish. We included 36 observational case-control and cohort studies that included patients with TGA according to the Caplan or Hodges and Warlow diagnostic criteria. We performed a meta-analysis with a random effect model for proportions and calculation of odds ratio (OR) for identified risk factors. Methodological quality was assessed according to the Newcastle-Ottawa scale.

Results: We identified 4,514 TGA cases and 544 recurrence events (12.73%). A follow-up had no effect on its variance. We identified a statistically significant association between recurrence and sexual activity as a trigger, a personal history or current state of migraine and depression (OR 1,481 95% CI [1.0341-2.1222] p = 0.04; OR = 2.0795 95% CI [1.3892-3.1128] p = 0.003; and OR = 4.4871 95% CI [1.890-10.651] p = 0.0288, respectively).

Discussion: The analysis showed that approximately 1 of 8 participants may experience recurrence, with an increased risk in the case of a history or current state of migraine, depression, or sexual intercourse before the event. A personal history of migraine and depression was associated with 2 and 4 times risk, respectively.