IS IT DEMENTIA OR EPILEPSY?
Abstract number :
1.035
Submission category :
Year :
2003
Submission ID :
3783
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Ahmed Al-Sadat, Jagdish Shah, Darren Fuerst, Dorothy Muriel, Craig Watson Department of Neurology, Wayne State University School of Medicine, Detroit, MI
Dementia is a common neuropsychiatric condition and occurs in 5 to 11% of the population by age 65 and up to 50% beyond age 85. Thus, a careful search for reversible causes of cognitive impairment is mandatory. One such example is newly diagnosed or poorly controlled epilepsy. Amnesia of the event is a common feature of complex partial seizures (CPS). Transient epileptic amnesia and epilepsy presenting as dementia have been occasionally reported. We report three patients masquerading as dementia, who presented with memory and cognitive impairment caused by frequent CPS and/or temporal lobe electrographic seizures (EEG Sz).
Of 600 consecutive patients admitted to the EEG/Video monitoring unit, we identified 3 patients who presented with memory disturbance and cognitive decline. All patients underwent scalp-sphenoidal EEG/Video monitoring, FDG-PET scanning, MRI, and neuropsychological evaluation.
On EEG/Video monitoring, all three patients had frequent CPS or EEG Sz. Seizure frequency ranged from 1 to 7 seizures per hour. No obvious clinical manifestations were seen on video recording. Subsequently, all three patients were loaded with intravenous antiepileptic medication, after which the EEG showed no further electrographic seizures. Family members noted significant improvement in memory and cognition. MRI results: Normal in one (patient#1), left temporal lobe encephalomalacia with left HS (patient#2), and left HS with increased signal in left temporal lobe white matter (patient#3).
FDG-PET results: Left temporal hypometabolism (#1), left temporoparietal hypometabolism (#2), and left temporoparietal hypometabolism with left thalamic hypometabolism (#3).
Frequent CPS or temporal lobe EEG Sz may present with memory and cognitive impairement. The usual clinical manifestations of CPS may be absent in these patients, and thus they may pose a diagnostic challange. A high degree of suscipion and awarness of this phenomenon may lead to proper diagnosis and managment. EEG/Video monitoring is an invaluable tool in this setting.