Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-06-01T06:45:26.764Z Has data issue: false hasContentIssue false

Chapter 1 - Epidemiology and Classification of Nonepileptic Seizures

from Section 1 - Recognition, Diagnosis, and Impact of Nonepileptic Seizures

Published online by Cambridge University Press:  18 May 2018

W. Curt LaFrance, Jr
Affiliation:
Brown Medical School, Providence
Steven C. Schachter
Affiliation:
Beth Israel Deaconess Medical Center, Boston
Get access

Summary

Image of the first page of this content. For PDF version, please use the ‘Save PDF’ preceeding this image.'
Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Szaflarski, JP, Hughes, C, Szaflarski, M, et al. Quality of life in psychogenic nonepileptic seizures. Epilepsia 2003;44:236242.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edn. (DSM-5). Washington, DC: American Psychiatric Association, 2013.Google Scholar
King, DW, Gallagher, BB, Murvin, AJ, et al. Pseudoseizures: diagnostic evaluation. Neurology 1982;32:1823.Google Scholar
Mace, CJ, Trimble, MR. ‘Hysteria’, ‘functional’ or ‘psychogenic’? A survey of British neurologists’ preferences. J R Soc Med 1991;84:471475.CrossRefGoogle ScholarPubMed
Scull, DA. Pseudoseizures or non-epileptic seizures (NES); 15 synonyms. J Neurol Neurosurg Psychiatry 1997;62:200.CrossRefGoogle ScholarPubMed
Szaflarski, JP, Ficker, DM, Cahill, WT, Privitera, MD. Four-year incidence of psychogenic nonepileptic seizures in adults in Hamilton County, OH. Neurology 2000;55:15611563.Google Scholar
Vanderzant, CW, Giordani, B, Berent, S, Dreifuss, FE, Sackellares, JC. Personality of patients with pseudoseizures. Neurology 1986;36:664668.Google Scholar
Benbadis, SR, Agrawal, V, Tatum, WO 4th. How many patients with psychogenic nonepileptic seizures also have epilepsy? Neurology 2001;57:915917.Google Scholar
Ferguson, PL, Chiprich, J, Smith, G, et al. Prevalence of self-reported epilepsy, health care access, and health behaviors among adults in South Carolina. Epilepsy Behav 2008;13:529534.Google Scholar
Kobau, R, Luo, Y-H, Zack, M, Helmers, SL, Thurman, DJ. Epilepsy in adults and access to care. MMWR Surveill Summ 2012;61:909913.Google Scholar
Reuber, M, Fernandez, G, Bauer, J, Helmstaedter, C, Elger, CE. Diagnostic delay in psychogenic nonepileptic seizures. Neurology 2002;58:493495.Google Scholar
Duncan, R, Razvi, S, Mulhern, S. Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 2011;20:308311.Google Scholar
Harden, CL, Burgut, FT, Kanner, AM. The diagnostic significance of video-EEG monitoring findings on pseudoseizure patients differs between neurologists and psychiatrists. Epilepsia 2003;44:453456.Google Scholar
Dworetzky, BA, Bubrick, EJ, Szaflarski, JP. Nonepileptic psychogenic status: markedly prolonged psychogenic nonepileptic seizures. Epilepsy Behav 2010;19:6568.Google Scholar
Szaflarski, JP, Aurora, K, Rawal, P, et al. Personalities of patients with nonepileptic psychogenic status. Epilepsy Behav 2015;52:143148.Google Scholar
Sigurdardottir, KR, Olafsson, E. Incidence of psychogenic seizures in adults: a population-based study in Iceland. Epilepsia 1998;39:749752.Google Scholar
Meierkord, H, Will, B, Fish, D, Shorvon, S. The clinical features and prognosis of pseudoseizures diagnosed using video-EEG telemetry. Neurology 1991;41:16431646.Google Scholar
Hauser, WA, Annegers, JF, Kurland, LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993;34:453468.Google Scholar
Kotsopoulos, I, de Krom, M, Kessels, F, et al. Incidence of epilepsy and predictive factors of epileptic and non-epileptic seizures. Seizure 2005;14:175182.CrossRefGoogle ScholarPubMed
Sirven, JI, Glosser, DS. Psychogenic nonepileptic seizures: theoretic and clinical considerations. Neuropsychiatry Neuropsychol Behav Neurol 1998;11:225235.Google Scholar
Benbadis, SR, Hauser, AW. An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure 2000;9:280281.CrossRefGoogle ScholarPubMed
Szaflarski, JP, Szaflarski, M. Seizure disorders, depression, and health-related quality of life. Epilepsy Behav 2004;5:5057.Google Scholar
Martin, RC, Gilliam, FG, Kilgore, M, Faught, E, Kuzniecky, R. Improved health care resource utilization following video-EEG-confirmed diagnosis of nonepileptic psychogenic seizures. Seizure 1998;7:385390.Google Scholar
Reuber, M, Pukrop, R, Mitchell, AJ, Bauer, J, Elger, CE. Clinical significance of recurrent psychogenic nonepileptic seizure status. J Neurol 2003;250:13551362.CrossRefGoogle ScholarPubMed
Asadi-Pooya, AA, Emami, Y, Emami, M, Sperling, MR. Prolonged psychogenic nonepileptic seizures or pseudostatus. Epilepsy Behav 2014;31:304306.CrossRefGoogle ScholarPubMed
Dworetzky, BA, Mortati, KA, Rossetti, AO, et al. Clinical characteristics of psychogenic nonepileptic seizure status in the long-term monitoring unit. Epilepsy Behav 2006;9:335338.Google Scholar
Sutula, TP, Sackellares, JC, Miller, JQ, Dreifuss, FE. Intensive monitoring in refractory epilepsy. Neurology 1981;31:243247.Google Scholar
Asadi-Pooya, AA, Emami, Y, Emami, M. Psychogenic non-epileptic seizures in Iran. Seizure 2014;23:175177.Google Scholar
Berkman, L, Kawachi, I. A historical framework for social epidemiology. In: Berkman, L, Kawachi, I, eds. Social Epidemiology. New York: Oxford University Press, 2000.Google Scholar
Schmitz, B. Psychogenic nonepileptic seizures: Why women? In: Schachter, SC, LaFrance, WC, eds. Gates and Rowan's Nonepileptic Seizures, 3rd edn. New York: Cambridge University Press, 2010;131135.Google Scholar
Duncan, R, Oto, M, Martin, E, Pelosi, A. Late onset psychogenic nonepileptic attacks. Neurology 2006;66:16441647.Google Scholar
Kessler, RC, Berglund, P, Demler, O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:593602.Google Scholar
Driver-Dunckley, E, Stonnington, CM, Locke, DE, Noe, K. Comparison of psychogenic movement disorders and psychogenic nonepileptic seizures: is phenotype clinically important? Psychosomatics 2011;52:337345.Google Scholar
Myers, L, Lancman, M, Laban-Grant, O, Matzner, B, Lancman, M. Psychogenic non-epileptic seizures: predisposing factors to diminished quality of life. Epilepsy Behav 2012;25:358362.Google Scholar
Syme, S. Foreword. In: Berkman, L, Kawachi, I, eds. Social Epidemiology. New York: Oxford University Press, 2000.Google Scholar
LaFrance, WC. Psychogenic nonepileptic seizures. Curr Opin Neurol 2008;21:195201.Google Scholar
Griffith, NM, Szaflarski, JP, Schefft, BK, et al. Relationship between semiology of psychogenic nonepileptic seizures and Minnesota Multiphasic Personality Inventory profile. Epilepsy Behav 2007;11:105111.Google Scholar
Selwa, LM, Geyer, J, Nikakhtar, N, et al. Nonepileptic seizure outcome varies by type of spell and duration of illness. Epilepsia 2000;41:13301334.Google Scholar
Gates, J. Epidemiology and classification of non-epileptic seizures. In: Gates, J, Rowan, A, eds. Non-Epileptic Seizures, 2nd edn. Boston: Butterworth-Heinemann, 2000;315.Google Scholar
Cragar, DE, Berry, DT, Schmitt, FA, Fakhoury, TA. Cluster analysis of normal personality traits in patients with psychogenic nonepileptic seizures. Epilepsy Behav 2005;6:593600.CrossRefGoogle ScholarPubMed
Reuber, M, Pukrop, R, Bauer, J, et al. Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients. Ann Neurol 2003;53:305311.CrossRefGoogle ScholarPubMed
LaFrance, WC, Plioplys, S. Neuropsychiatric disorders: does semiology of psychogenic nonepileptic seizures matter? Nat Rev Neurol 2012;8:302303.Google Scholar
Trimble, MR. Pseudoseizures. Neurol Clin 1986;4:531548.Google Scholar
Kretschmer, E. Hysteria. New York: Nervous and Mental Disease Publ. Co., 1926.Google Scholar
Blumer, D, Adamolekun, B. Treatment of patients with coexisting epileptic and nonepileptic seizures. Epilepsy Behav 2006;9:498502.Google Scholar
Reuber, M, Pukrop, R, Bauer, J, Derfuss, R, Elger, CE. Multidimensional assessment of personality in patients with psychogenic non-epileptic seizures. J Neurol Neurosurg Psychiatry 2004;75:743748.Google Scholar
Wilkus, RJ, Dodrill, CB. Factors affecting the outcome of MMPI and neuropsychological assessments of psychogenic and epileptic seizure patients. Epilepsia 1989;30:339347.Google Scholar
Gulick, TA, Spinks, IP, King, DW. Pseudoseizures: ictal phenomena. Neurology 1982;32:2430.Google Scholar
Henry, TR, Drury, I. Ictal behaviors during nonepileptic seizures differ in patients with temporal lobe interictal epileptiform EEG activity and patients without interictal epileptiform EEG abnormalities. Epilepsia 1998;39:175182.CrossRefGoogle ScholarPubMed
Flugel, D, Bauer, J, Kaseborn, U, Burr, W, Elger, C. Closed eyes during a seizure indicate psychogenic etiology: a study with suggestive seizure provocation. J Epilepsy 1996;9:165169.Google Scholar
Gumnit, RJ, Gates, JR. Psychogenic seizures. Epilepsia 1986;27(Suppl 2):S124129.Google Scholar
van Merode, T, de Krom, MC, Knottnerus, JA. Gender-related differences in non-epileptic attacks: a study of patients' cases in the literature. Seizure 1997;6:311316.Google Scholar
Groppel, G, Kapitany, T, Baumgartner, C. Cluster analysis of clinical seizure semiology of psychogenic nonepileptic seizures. Epilepsia 2000;41:610614.Google Scholar
Dworetzky, BA, Strahonja-Packard, A, Shanahan, CW, et al. Characteristics of male veterans with psychogenic nonepileptic seizures. Epilepsia 2005;46:14181422.Google Scholar
Kanner, AM, Morris, HH, Luders, H, et al. Supplementary motor seizures mimicking pseudoseizures: some clinical differences. Neurology 1990;40:14041407.Google Scholar
Saygi, S, Katz, A, Marks, DA, Spencer, SS. Frontal lobe partial seizures and psychogenic seizures: comparison of clinical and ictal characteristics. Neurology 1992;42:12741277.Google Scholar
Hubsch, C, Baumann, C, Hingray, C, et al. Clinical classification of psychogenic non-epileptic seizures based on video-EEG analysis and automatic clustering. J Neurol Neurosurg Psychiatry 2011;82:955960.Google Scholar
Seneviratne, U, Reutens, D, D'Souza, W. Stereotypy of psychogenic nonepileptic seizures: insights from video-EEG monitoring. Epilepsia 2010;51:11591168.Google Scholar
Cragar, D, Berry, D, Fakhoury, T, Cibula, J, Schmitt, F. A review of diagnostic techniques in the differential diagnosis of epileptic and nonepileptic seizures. Neuropsychol Rev 2002;12:3164.Google Scholar
Dodrill, C, Wilkus, R, Batzel, L. The MMPI as a diagnostic tool in non-epileptic seizures. In: Gates, J, Rowan, A, eds. Non-Epileptic Seizures. Boston: Butterworth-Heinemann, 1993:211220.Google Scholar
Gale, SD, Hill, SW. Concurrent administration of the MMPI-2 and PAI in a sample of patients with epileptic or non-epileptic seizures: implications for an inpatient epilepsy monitoring unit. Epilepsy Behav 2012;25:181184.Google Scholar
King, TZ, Fennell, EB, Bauer, R, et al. MMPI-2 profiles of patients with intractable epilepsy. Arch Clin Neuropsychol 2002;17:583593.Google Scholar
Kalogjera-Sackellares, D, Sackellares, JC. Personality profiles of patients with pseudoseizures. Seizure 1997;6:17.Google Scholar
Kuyk, J, Swinkels, WA, Spinhoven, P. Psychopathologies in patients with nonepileptic seizures with and without comorbid epilepsy: how different are they? Epilepsy Behav 2003;4:1318.Google Scholar
Reuber, M, Howlett, S, Kemp, S. Psychologic treatment of patients with psychogenic nonepileptic seizures. Expert Rev Neurother 2005;5:737752.Google Scholar
Barrash, J, Gates, J, Heck, D, Benial, T. MMPI subtypes among patients with nonepileptic events. In: Annual Meeting of the American Epilepsy Society; Boston: Raven Press, Ltd., 1989;730731.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association, 2000.Google Scholar
Reuber, M. Psychogenic nonepileptic seizures: answers and questions. Epilepsy Behav 2008;12:622635.Google Scholar
Livesley, WJ, Jackson, DN, Schroeder, ML. Factorial structure of traits delineating personality disorders in clinical and general population samples. J Abnorm Psychol 1992;101:432440.Google Scholar
Chang, E, ed. Optimism and Pessimism: Implications for Theory, Research, and Practice. Washington, DC: American Psychological Association, 2002.Google Scholar
Gillham, J, ed. The Science of Optimism and Hope: Research Essays in Honor of Martin E. P. Seligman. Philadelphia: Templeton Foundation Press, 2000.Google Scholar
Costa, P, McCrae, R. NEO-PI-R Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc., 1992.Google Scholar
Wagner, MT, Wymer, JH, Topping, KB, Pritchard, PB. Use of the Personality Assessment Inventory as an efficacious and cost-effective diagnostic tool for nonepileptic seizures. Epilepsy Behav 2005;7:301304.Google Scholar
Testa, SM, Lesser, RP, Krauss, GL, Brandt, J. Personality Assessment Inventory among patients with psychogenic seizures and those with epilepsy. Epilepsia 2011;52:e8488.Google ScholarPubMed
Thompson, AW, Hantke, N, Phatak, V, Chaytor, N. The Personality Assessment Inventory as a tool for diagnosing psychogenic nonepileptic seizures. Epilepsia 2010;51:161164.Google Scholar
Alsaadi, TM, Marquez, AV. Psychogenic nonepileptic seizures. Am Fam Physician 2005;72:849856.Google Scholar
Lesser, RP. Treatment and outcome of psychogenic nonepileptic seizures. Epilepsy Curr 2003;3:198200.Google Scholar
Ford, C. Somatization and non-epileptic seizures. In: Rowan, A, Gates, J, eds. Non-Epileptic Seizures. Boston: Butterworth-Heinemann, 1993:153164.Google Scholar
Bowman, ES. Etiology and clinical course of pseudoseizures. Relationship to trauma, depression, and dissociation. Psychosomatics 1993;34:333342.Google Scholar
Bowman, ES, Markand, ON. Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. Am J Psychiatry 1996;153:5763.Google ScholarPubMed
Rusch, MD, Morris, GL, Allen, L, Lathrop, L. Psychological treatment of nonepileptic events. Epilepsy Behav 2001;2:277283.Google Scholar
LaFrance, WC, Devinsky, O. Treatment of nonepileptic seizures. Epilepsy Behav 2002;3:1923.Google Scholar
LaFrance, WC, Baker, GA, Duncan, R, Goldstein, LH, Reuber, M. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia 2013;54:20052018.Google Scholar
Zivin, L, Marsan, CA. Incidence and prognostic significance of “epileptiform” activity in the EEG of non-epileptic subjects. Brain 1968;91:751778.Google Scholar
Lin, JT, Ziegler, DK, Lai, CW, Bayer, W. Convulsive syncope in blood donors. Ann Neurol 1982;11:525528.Google Scholar
Aminoff, MJ, Scheinman, MM, Griffin, JC, Herre, JM. Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias. Ann Intern Med 1988;108:791796.Google Scholar
Kleindorfer, D, Panagos, P, Pancioli, A, et al. Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke 2005;36:720723.Google Scholar
Stewart, WF, Linet, MS, Celentano, DD, Van Natta, M, Ziegler, D. Age- and sex-specific incidence rates of migraine with and without visual aura. Am J Epidemiol 1991;134:11111120.CrossRefGoogle ScholarPubMed
Brown, RJ, Cardena, E, Nijenhuis, E, Sar, V, van der Hart, O. Should conversion disorder be reclassified as a dissociative disorder in DSM V? Psychosomatics 2007;48:369378.CrossRefGoogle ScholarPubMed
Brown, RJ, Trimble, MR. Dissociative psychopathology, non-epileptic seizures, and neurology. J Neurol Neurosurg Psychiatry 2000;69:285289.Google Scholar
Reuber, M, House, AO. Treating patients with psychogenic non-epileptic seizures. Curr Opin Neurol 2002;15:207211.CrossRefGoogle ScholarPubMed
Reuber, M, Elger, CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav 2003;4:205216.Google Scholar
Reuber, M, Howlett, S, Khan, A, Grunewald, RA. Non-epileptic seizures and other functional neurological symptoms: predisposing, precipitating, and perpetuating factors. Psychosomatics 2007;48:230238.Google Scholar
Torem, M. Non-Epileptic seizures as a dissocative disorder. In: Rowan, A, Gates, J, eds. Non-Epileptic Seizures. Boston: Butterworth-Heinemann, 1993;173179.Google Scholar
Prueter, C, Schultz-Venrath, U, Rimpau, W. Dissociative and associated psychopathological symptoms in patients with epilepsy, pseudoseizures, and both seizure forms. Epilepsia 2002;43:188192.Google Scholar
van Merode, T, Twellaar, M, Kotsopoulos, IA, et al. Psychological characteristics of patients with newly developed psychogenic seizures. J Neurol Neurosurg Psychiatry 2004;75:11751177.Google Scholar
Fleisher, W, Staley, D, Krawetz, P, et al. Comparative study of trauma-related phenomena in subjects with pseudoseizures and subjects with epilepsy. Am J Psychiatry 2002;159:660663.Google Scholar
Kuyk, J, Van Dyck, R, Spinhoven, P. The case for a dissociative interpretation of pseudoepileptic seizures. J Nerv Ment Dis 1996;184:468474.Google Scholar
Alper, K, Devinsky, O, Perrine, K, et al. Dissociation in epilepsy and conversion nonepileptic seizures. Epilepsia 1997;38:991997.Google Scholar
Alper, K, Devinsky, O, Perrine, K, Vazquez, B, Luciano, D. Psychiatric classification of nonconversion nonepileptic seizures. Arch Neurol 1995;52:199201.Google Scholar
Reuber, M, House, AO, Pukrop, R, Bauer, J, Elger, CE. Somatization, dissociation and general psychopathology in patients with psychogenic non-epileptic seizures. Epilepsy Res 2003;57:159167.Google Scholar
Tojek, TM, Lumley, M, Barkley, G, Mahr, G, Thomas, A. Stress and other psychosocial characteristics of patients with psychogenic nonepileptic seizures. Psychosomatics 2000;41:221226.Google Scholar
Harden, CL. Pseudoseizures and dissociative disorders: a common mechanism involving traumatic experiences. Seizure 1997;6:151155.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 2nd edn. (DSM-II). Washington, DC: American Psychiatric Press, 1968.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. (DSM-III). Washington, DC: American Psychiatric Press, 1980.Google Scholar
Martin, R, Gates, J. Nosology, classification, and differential diagnosis of non-epileptic seizures: an alternative proposal. In: Gates, J, Rowan, A, eds. Non-Epileptic Seizures, 2nd edn. Boston: Butterworth-Heinemann, 2000;253267.Google Scholar
Bowman, ES. Nonepileptic seizures: psychiatric framework, treatment, and outcome. Neurology 1999;53:S8488.Google Scholar
Lacey, C, Cook, M, Salzberg, M. The neurologist, psychogenic nonepileptic seizures, and borderline personality disorder. Epilepsy Behav 2007;11:492498.Google Scholar
Chabolla, DR, Krahn, LE, So, EL, Rummans, TA. Psychogenic nonepileptic seizures. Mayo Clin Proc 1996;71:493500.Google Scholar
Gates, J. Nonepileptic seizures: classification, coexistence with epilepsy, diagnosis, therapeutic approaches, and consensus. Epilepsy Behav 2002;3:2833.Google Scholar
Fiszman, A, Alves-Leon, SV, Nunes, RG, D'Andrea, I, Figueira, I. Traumatic events and posttraumatic stress disorder in patients with psychogenic nonepileptic seizures: a critical review. Epilepsy Behav 2004;5:818825.Google Scholar
Brewin, CR, Andrews, B, Rose, S, Kirk, M. Acute stress disorder and posttraumatic stress disorder in victims of violent crime. Am J Psychiatry 1999;156:360366.Google Scholar
LaFrance, WC, Barry, JJ. Update on treatments of psychological nonepileptic seizures. Epilepsy Behav 2005;7:364374.Google Scholar
Wessely, S, White, PD. There is only one functional somatic syndrome. Br J Psychiatry 2004;185:9596.Google Scholar
Schoenberg, MR, Marsh, PJ, Benbadis, SR. Where are somatoform disorders going? An update on the DSM-V. Expert Rev Neurother 2012;12:13711374.Google Scholar
Stone, J, LaFrance, WC, Brown, R, et al. Conversion disorder: current problems and potential solutions for DSM-5. J Psychosomatic Res 2011;71:369376.Google Scholar
Stone, J, LaFrance, WC, Levenson, JL, Sharpe, M. Issues for DSM-5: Conversion disorder. Am J Psychiatry 2010;167:626627.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×