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  1. A Randall,
  2. AJ Larner
  1. The Walton Centre


Objective Every neurologist has encountered patients who present a (long) written list of symptoms: la maladie du petit papier. The frequency and diagnostic utility of this sign was examined.

Results Over 6-months (April–September 2015), la maladie du petit papier was observed in 17/508 (3.35%) consecutive new patient referrals (16 handwritten examples, 1 ipad). Referrals to general (9/339=2.65%) and cognitive disorders clinics (8/169=4.73%) showed no significant frequency difference (chi-square=1.07, p>0.1). Final diagnoses in the general clinic were chronic daily headache (3), multiple symptoms with no neurological explanation (5) and unexplained blackouts (1). In the cognitive clinic, diagnoses were subjective memory complaint (5), mild cognitive dysfunction secondary to either alcohol misuse (1) or mild traumatic brain injury (1), and depression (1); none had dementia. La maladie du petit papier had high specificity (0.94) but low sensitivity (0.03) for cognitive impairment.

Conclusions La maladie du petit papier is an infrequent sign in both general and cognitive disorders clinics. In general clinics it was associated with chronic and intractable disorders (headache, multiple symptoms). In cognitive clinics it was associated with subjective memory complaint; like the “attended alone” sign, it may support a diagnosis of cognitive normality.

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