Abstracts

Rationale: Transient epileptic amnesia (TEA, Kapur) is a syndrome which has variously been termed epileptic amnesic attacks (Pritchard, Holmstrom, et al.), epileptic amnesic syndrome (Gallassi, Morreale et al.), pure amnestic seizures (Palmini, Gloor, et al.), and epileptic transient amnesia (Stracciari, Ciucci, et al.). The central feature is recurrent attacks during which there is anterograde memory malfunction while consciousness is preserved. We describe three patients with episodic amnesia who also recounted discrete episodes of disordered autobiographical memory during which they behaved as though they had resumed their life circumstances of 20-30 years in the past. For example, one woman excitedly called her husband at work to report "we've got to pack up fast because the owners are on their way to move back into the apartment." Each time her husband rushed back home from work to remind her that they no longer lived in the rented home of 20 years ago and that they were now homeowners and not compelled to move out! Methods: We performed a retrospective analysis of clinical features, EEG, and VEEG in each case, as well as neuropsychological evaluations in two cases. We also reviewed brain imaging and responses to antiepilepic drugs in each case. Results: All three patients experienced complex partial seizures (CPS) and episodic amnesia. In addition, each of them experienced episodes in which they believed themselves to be at an earlier point in their lives, as long as 20-30 years in their past. Patient 1 also had a more pervasive memory disorder consistent with mild cognitive impairment, as reflected in neuropsychological testing. Historical characteristics of the group are depicted in Table 1. Each of them underwent EEG and MRI brain scans, and two out of the three were monitored with video-EEG (VEEG) recording as outline in Table 2. For patients 1 and 2, who had bilateral temporal spikes, spike counts demonstrated a preponderance of left temporal spikes for patient 1 and disproportionate right temporal spikes for patient 2. A 24 hour spike count in patient 1 showed that maximum temporal lobe spike frequency occurred during the time when she was most prone to have auto-biographical memory attacks. All three patients attained complete control of autobiographical memory attacks and transient epileptic amnesia episodes with antiepileptic drugs (two with oxcarbazepine and one with a combination of lamotrigine and levetiracetam. Followup neuropsychological testing in Patient 1 failed to demonstrate any significant improvement in her mild cognitive impairment. Conclusions: 1. Episodic autobiographical memory dysfunction may occur in patients who have transient epileptic amnesia (TEA). 2. Antiepileptic drugs are affective treatment of transient epileptic amnesia and autobiographic memory attacks.