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Mazzacane F, Ferrari F, Malvaso A, Mottese Y, Gastaldi M, Costa A, Pichiecchio A, Cavallini A. Acute amnestic syndrome in fornix lesions: a systematic review of reported cases with a focus on differential diagnosis. Front Neurol 2024; 15:1338291. [PMID: 38333604 PMCID: PMC10850356 DOI: 10.3389/fneur.2024.1338291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Acute amnestic syndrome is an uncommon clinical presentation of neurological disease. Differential diagnosis encompasses several syndromes including Wernicke-Korsakoff and transient global amnesia (TGA). Structural lesions of the fornix account for a minority of cases of acute amnestic syndromes. Etiology varies from iatrogenic injury to ischemic, inflammatory, or neoplastic lesions. A prompt diagnosis of the underlying pathology is essential but challenging. The aim of this review is to systematically review the existing literature regarding cases of acute amnestic syndrome associated with non-iatrogenic lesions of the fornix. Methods We performed a systematic literature search on PubMed, Scopus, and Web of Science up to September 2023 to identify case reports and case series of patients with amnestic syndrome due to fornix lesions. The systematic review was conducted according to PRISMA guidelines. The research was limited to articles written in English. Cases of fornix damage directly ascribable to a surgical procedure were excluded. Results A total of 52 publications reporting 55 cases were included in the review. Focusing on acute/subacute onset, vascular etiology was highly prevalent, being responsible for 78% of cases, 40/55 (74%) of which were due to acute ischemic stroke. The amnestic syndrome was characterized by anterograde amnesia in all patients, associated with retrograde amnesia in 27% of cases. Amnesia was an isolated presentation in most cases. Up to two thirds of patients had persistent memory deficits of any severity at follow-up. Discussion Acute amnestic syndrome can be rarely caused by fornix lesions. In most cases of acute/subacute presentation, the etiology is ischemic stroke, mainly caused by strokes involving the subcallosal artery territory. The differential diagnosis is challenging and a distinction from common mimics is often difficult on a clinical basis. A high index of suspicion should be maintained to avoid misdiagnosis and provide adequate acute treatment to patients with time-dependent disease, also employing advanced neuroimaging. More research is needed to better understand the outcome and identify prognostic factors in patients with amnestic syndrome due to fornix lesions.
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Affiliation(s)
- F. Mazzacane
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
- Unit of Behavioral Neurology, Mondino Foundation, Pavia, Italy
| | - F. Ferrari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - A. Malvaso
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroimmunology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Y. Mottese
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - M. Gastaldi
- Neuroimmunology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - A. Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology, Mondino Foundation, Pavia, Italy
| | - A. Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - A. Cavallini
- Department of Emergency Neurology and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
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Cretin B, Philippi N, Bousiges O, Blanc F. Transient epileptic amnesia: a retrospective cohort study of 127 cases, including CSF amyloid and tau features. J Neurol 2023; 270:2256-2270. [PMID: 36715748 DOI: 10.1007/s00415-023-11576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transient epileptic amnesia (TEA) is a late-onset epilepsy syndrome encompassing transient iterative amnesias and interictal cognitive impairment, two features that overlap with incipient neurodegenerative dementias. We, therefore, examined the yield of CSF amyloid and tau biomarkers in TEA. METHODS In this retrospective study, 127 TEA patients with unremarkable imaging findings were divided into 2 groups, namely, CSF (n = 71) and no-CSF (n = 56). Both were compared for demographics; medical history; baseline neurological, cognitive, and behavioral features; baseline mesial temporal lobe atrophy; and cognitive follow-up at a median of 13 months. CSF samples were examined for amyloid β-42 peptide as well as phospho-tau and total-tau levels. RESULTS At baseline, the CSF-TEA group had significantly (p < 0.01) more frequent mild parkinsonism (42.9% vs. 20%) and cognitive concerns (31% vs. 10.7%), a more blunted sense of smell (34.3% vs. 9.4%), a lower baseline MMSE score (27 vs. 28.9), a more frequent amnestic mild cognitive impairment profile (69% vs. 42.6%), and more atrophic hippocampal changes. At follow-up, the CSF-TEA group had significantly (p < 0.01) lower MMSE scores (27.8 vs. 28.9). CSF analyses revealed amyloid and/or tau changes in 27 patients (38%), including an Alzheimer's disease (AD) profile in 17 (24%). CONCLUSIONS This study shows a good diagnostic value of CSF sampling in a specific population of TEA with characteristics suggestive of incipient degenerative diseases (i.e., red flags). It argues for TEA being the inaugurating feature in some cases of AD. More broadly, our results suggest an etiological heterogeneity in TEA.
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Affiliation(s)
- Benjamin Cretin
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200, Strasbourg, France.
- Unité de Neuropsychologie, Service de Neurologie et hôpital de jour de Gériatrie, pôle de Gériatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto Strasbourg, Strasbourg, France.
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Nathalie Philippi
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200, Strasbourg, France
- Unité de Neuropsychologie, Service de Neurologie et hôpital de jour de Gériatrie, pôle de Gériatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto Strasbourg, Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Bousiges
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200, Strasbourg, France
- University Hospital of Strasbourg, Laboratory of Biochemistry and Molecular Biology, CNRS, Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR7364, Strasbourg, France
| | - Frédéric Blanc
- Centre Mémoire, de Ressources et de Recherche d'Alsace (Strasbourg-Colmar), Service de Neurologie des Hôpitaux Universitaires de Strasbourg, Pôle Tête et Cou, 1 Avenue Molière, 67200, Strasbourg, France
- Unité de Neuropsychologie, Service de Neurologie et hôpital de jour de Gériatrie, pôle de Gériatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto Strasbourg, Strasbourg, France
- Centre de Compétences des démences rares des Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Voronkova KV, Alieva AM, Nikitin IG, Musina GM, Surskaya EV, Zaitseva OS, Mashkevich NG, Gomonova LV, Petrukhin AS. [The role of the phenosanic acid in the combined treatment of patients with epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:151-157. [PMID: 36843473 DOI: 10.17116/jnevro2023123021151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Epilepsy is one of the most studied chronic neurological disorders in the world. Despite significant progress in epilepsy research, some patients continue to experience recurrent seizures. It has been proven that oxidative stress plays an important role in epilepsy. Targeting oxidative stress may provide a novel therapeutic intervention to attenuate epileptogenesis as well as cognitive and psychiatric impairment in patients with epilepsy. One of the promising directions in the search for new strategies for the treatment of epilepsy is the combined use of antiepileptic drugs with antioxidants that affect the pathogenetic links of this disease. The new Russian antiepileptic drug fenosanoic acid (Dibufelon) has an anticonvulsant effect due to the inhibition of lipid peroxidation of brain cells and the reconstruction of cell membranes. This mechanism of action also paves the way for an increase in the effectiveness of co-administered drugs with phenosanoic acid. The effect of the drug on the cognitive and mental functions of patients, the regression of asthenia phenomena is also observed. The clinical efficacy and safety of the combination of this drug with other antiepileptic drugs in epilepsy has been demonstrated in experimental and clinical studies.
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Affiliation(s)
- K V Voronkova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - A M Alieva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I G Nikitin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G M Musina
- Medical Center NORIS, Sterlitamak, Russia
| | - E V Surskaya
- Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - O S Zaitseva
- Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - N G Mashkevich
- Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - L V Gomonova
- Petrovsky Russian Scientific Center for Surgery, Moscow, Russia
| | - A S Petrukhin
- Pirogov Russian National Research Medical University, Moscow, Russia
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4
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Ropper AH. Transient Global Amnesia. N Engl J Med 2023; 388:635-640. [PMID: 36791163 DOI: 10.1056/nejmra2213867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Pukropski J, von Wrede R, Helmstaedter C, Surges R. [Transient epileptic amnesia-A rare phenomenon in temporal lobe epilepsies]. DER NERVENARZT 2022; 93:1193-1205. [PMID: 35920860 PMCID: PMC9718864 DOI: 10.1007/s00115-022-01364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Transient epileptic amnesia (TEA) is a rare phenomenon in temporal lobe epilepsy that is often unrecognized or misdiagnosed as transient global amnesia (TGA). It is postulated that TEA is due to both ictal and postictal disturbances. Response to antiseizure medication underlines its epileptic nature. In view of the increasing incidence of new-onset epilepsies in old age, an increase in TEA can be expected in the future. OBJECTIVE Analysis of TEA features in a monocentric case series. MATERIAL AND METHODS A search in our electronic patient data base yielded 10 patients with TEA out of 7899 patients over a period of 8 years. Clinical and paraclinical features as well as findings of additional examinations were retrospectively collected. Data are given as mean ± SD. RESULTS All 10 patients were diagnosed with temporal lobe epilepsy. The mean age at manifestation of TEA was 59.1 ± 6.7 years, the diagnosis was made with a delay of 21.9 ± 26.3 months. The TEA lasted on average 56 ± 37 min, and 16 ± 9.9 TEA episodes per year were reported by the patients; out of the 10 patients 6 reported that TEA usually occurred upon awakening. In 9 of 10 patients, there was evidence of typical seizure symptoms or other semiological elements during TEA. Interictal neuropsychological disturbances of temporal functions were seen in 8 of 10 patients and evidence of depressive disorder in 6 of 10 patients. Video EEG recordings revealed epileptiform activity during sleep in 4 patients over the left and in 2 patients over both temporal regions. In 3 patients, magnetic resonance imaging displayed typical alterations of the temporomesial structures (in 2 patients on the left and in 1 the right side). Antiseizure medication improved seizure control in 7 of 10 patients (seizure freedom in 6 patients), 3 patients were lost to follow-up. DISCUSSION TEA is rare, occurs in older adults and is correctly diagnosed after about 2 years. Thorough assessment of additional symptoms and circumstances, the recurrent occurrence as well as typical EEG and imaging findings of temporal lobe epilepsy enables the distinction between TEA and TGA.
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Affiliation(s)
- Jan Pukropski
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Randi von Wrede
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Christoph Helmstaedter
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Rainer Surges
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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EPIAMNE: A New Scoring System for Differentiating Transient EPIleptic AMNEsia from Transient Global Amnesia. Brain Sci 2022; 12:brainsci12121632. [PMID: 36552092 PMCID: PMC9775429 DOI: 10.3390/brainsci12121632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/13/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Transient epileptic amnesia (TEA) is a rare cause of acute amnestic syndromes (AAS), often misdiagnosed as transient global amnesia (TGA). We proposed a scoring system—the EPIlepsy AMNEsia (EPIAMNE) score—using quantitative EEG (qEEG) analysis to obtain a tool for differentiating TEA from TGA. We retrospectively reviewed clinical information and standard EEGs (stEEG) of 19 patients with TEA and 21 with TGA. We computed and compared Power Spectral Density, demonstrating an increased relative theta power in TGA. We subsequently incorporated qEEG features in EPIAMNE score, together with clinical and stEEG features. ROC curve models and pairwise ROC curve comparison were used to evaluate and compare the diagnostic accuracy for TEA detection of EPIAMNE score, presence of symptoms atypical for TGA (pSymAT) and identification of anomalies (interictal epileptiform or temporal focal spiky transients) at stEEG (PosEEG). Area Under the Curve (AUC) of EPIAMNE score revealed to be higher than PosEEG and pSymAT (AUCEPIAMNE = 0.95, AUCpSymAT = 0.85, AUCPosEEG = 0.67) and this superiority proved to be statistically significant (p-valueEPIAMNE-PosEEG and p-valueEPIAMNE-pSymAT < 0.05). In conclusion, EPIAMNE score classified TEA with higher accuracy than PosEEG and pSymAT. This approach could become a promising tool for the differential diagnosis of AAS, especially for early TEA detection.
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Evaluation of the Patient With Paroxysmal Spells Mimicking Epileptic Seizures. Neurologist 2022:00127893-990000000-00040. [PMID: 36223312 DOI: 10.1097/nrl.0000000000000469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The diagnostic issue of paroxysmal spells, including epileptic seizure (ES) mimics, is one that neurologists frequently encounter. This review provides an up-to-date overview of the most common causes of ES mimics encountered in the outpatient setting. REVIEW SUMMARY Paroxysmal spells are characterized by changes in awareness, attention, perception, or abnormal movements. These can be broadly classified as ES and nonepileptic spells (NES). NES mimics ES but are distinguished by their symptomatology and lack of epileptiform activity on electroencephalography. NES may have psychological or physiological underpinnings. Psychogenic non-ES are the most common mimics of ES. Physiological causes of NES include syncope, cerebrovascular, movement, and sleep-related disorders. CONCLUSIONS Distinguishing NES from ES at times may be challenging even to the most experienced clinicians. However, detailed history with an emphasis on the clinical clues, including taking a moment-by-moment history of the event from the patient and observers and physical examination, helps create an appropriate differential diagnosis to guide further diagnostic testing. An accurate diagnosis of NES prevents iatrogenic harm, including unnecessary exposure to antiseizure medications and overuse of health care resources. It also allows for the correct specialist referral and appropriate treatment.
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Bouyer C, de Toffol B. Case Report: Cognitive Assessment Before an Amnesic Seizure in Transient Epileptic Amnesia Syndrome. Front Neurol 2022; 13:919706. [PMID: 35860486 PMCID: PMC9289512 DOI: 10.3389/fneur.2022.919706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
A patient with transient epileptic amnesia syndrome presented a clinically observable amnesic seizure immediately after a neuropsychological assessment. An hour and a half before the onset of the seizure, the patient progressively developed an isolated alteration of episodic memory. These data question the ictal/interictal distinction in this syndrome as well as the speed of propagation of an epileptic activity.
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Affiliation(s)
- Coline Bouyer
- Service de neurologie Centre Hospitalier de Cayenne, Cayenne, France
- *Correspondence: Coline Bouyer
| | - Bertrand de Toffol
- Service de neurologie Centre Hospitalier de Cayenne, Cayenne, France
- CIC Inserm 1424 CH Cayenne, Cayenne, France
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Uehara T, Akamatsu N, Tomura M, Yamashita C, Taira A, Suezumi K, Murai H. Waking amnesia as a postictal symptom after seizure-induced arousal in a patient with transient epileptic amnesia: An ictal video-electroencephalogram finding. Seizure 2022; 100:21-23. [PMID: 35724522 DOI: 10.1016/j.seizure.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Taira Uehara
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan.
| | - Naoki Akamatsu
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Masaki Tomura
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Chikara Yamashita
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Akihiko Taira
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Koki Suezumi
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Hiroyuki Murai
- Department of Neurology, International University of Health and Welfare, Narita Hospital, Narita, Japan
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Miller TD, Butler CR. Acute-onset amnesia: transient global amnesia and other causes. Pract Neurol 2022; 22:201-208. [PMID: 35504698 DOI: 10.1136/practneurol-2020-002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 11/04/2022]
Abstract
Acute-onset amnesia is a dramatic neurological presentation that can cause considerable concern to both patient and clinician. The patient typically presents with an inability not only to retain new memories but also to access previously acquired memories, suggesting disturbance of hippocampal function. Transient global amnesia (TGA) is the most common cause of acute-onset amnesia, and is characterised by a profound anterograde and retrograde amnesia that typically lasts for up to 24 hours. Although TGA has a strikingly stereotypical presentation, it can be challenging to distinguish from other causes of acute-onset amnesia, including posterior circulation strokes, transient epileptic amnesia, psychogenic amnesia, post-traumatic amnesia, and toxic/drug-related amnesia. Here, we describe the general approach to the patient with acute amnesia; summarise the clinical and neuropsychological differences between the potential causes; and, provide practical recommendations to aid diagnosis and management of acute amnesia. Regardless of cause and the dramatic presentation, non-ischaemic acute-onset amnesia generally has a favourable prognosis.
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Affiliation(s)
- Thomas D Miller
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK .,National Hospital for Neurology and Neurosurgery, London, UK
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Savage SA, Baker J, Milton F, Butler C, Zeman A. Clinical outcomes in Transient Epileptic Amnesia: a 10-year follow-up cohort study of 47 cases. Epilepsia 2022; 63:1115-1129. [PMID: 35253220 PMCID: PMC9310913 DOI: 10.1111/epi.17214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
Objective Transient epileptic amnesia (TEA) is a form of adult‐onset epilepsy where presenting features are well described, but little is known regarding prognosis. This study aimed to elucidate the long‐term prognosis of TEA regarding seizure control, memory, medical comorbidities, and life expectancy. Methods Up‐to‐date clinical information was collected for 47 people diagnosed with TEA who had joined the The Impairment of Memory in Epilepsy (TIME) study 10 years earlier. At entry to the study, information about comorbid conditions was systematically collected. Details regarding subsequent diagnoses, seizure activity, changes to treatment, or reports of cognitive impairment were obtained through the family doctor. The variables of interest were compared with UK population data. Results Mortality in the cohort was 21 of 47 (45%), with an average age at death of 82.5 years. Seizures remained well controlled for the majority but medications required adjustments in dose and type for some (28%). A small number (three cases) remained seizure‐free without medication. History of cardiovascular disorders was frequent (78.7%), typically involving hypertension (55.3%). Autoimmune disorders (25.5%), cancer (23.4%), and depression (21.3%) were also commonly reported. Although persisting memory problems were often noted, dementia was diagnosed in seven cases (14.9%). Life expectancy and comorbidities in TEA did not differ from available population norms. Significance Results suggest that life expectancy is not reduced in TEA. Although TEA does not appear to be a self‐limiting form of epilepsy, seizures are typically well controlled via medication. Because adjustments to medication may be required, even after long periods of stability, ongoing medical monitoring is recommended. Comorbid vascular disorders are frequent but appear similar to general population estimates. Monitoring mood may be important, given that people with chronic conditions are often vulnerable to depression. Because of persisting memory difficulties, the development of effective memory interventions for people with TEA is warranted.
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Affiliation(s)
- Sharon A Savage
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK.,School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - John Baker
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK.,Dementia Research Centre, UCL Queen Square institute of Neurology, London, WC1N 3BG, UK
| | - Fraser Milton
- Discipline of Psychology, University of Exeter, Washington Singer Laboratories, Exeter, EX4 4QG, UK
| | - Chris Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Department of Brain Sciences, Imperial College, London, W12 0NN, UK
| | - Adam Zeman
- Cognitive & Behavioural Neurology, University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK
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Wang X, Mu P, Zhang W, Liu Y. Case Report: Not All Neurological Symptoms Respond Well to Penicillin in Patients With Neurosyphilis. Front Neurol 2022; 12:813829. [PMID: 35140678 PMCID: PMC8820373 DOI: 10.3389/fneur.2021.813829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with neurosyphilis present with a wide range of neurological symptoms, the response of which to penicillin is not well known. In this paper, we analyzed the clinical video-electroencephalogram (EEG) features of neurosyphilis in a 54-year-old man who exhibited with rhythmic orofacial involuntary movements, Argyll Robertson pupil, frequent paroxysmal oral-automatism seizures, periodic lateralized discharges (PLEDs) with triphasic waves, behavioral changes, and memory decline. After treatment with penicillin, PLED and seizures disappeared and behavioral changes and memory decline were significantly improved, but rhythmic orofacial involuntary movements and Argyll Robertson pupil persisted, which indicates an irreversible characteristic of late stage neurosyphilis syndromes.
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Affiliation(s)
- Xiaoli Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Pengying Mu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Department of Neurology, Xing Yuan hospital of Yulin, Shaanxi, China
| | - Wenjuan Zhang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- *Correspondence: Yonghong Liu
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Transient Epileptic Amnesia With Amygdala Enlargement Presenting to a Dementia Clinic. Dement Neurocogn Disord 2022; 21:103-106. [PMID: 35949422 PMCID: PMC9340246 DOI: 10.12779/dnd.2022.21.3.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
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Larner A. Transient global amnesia: model, mechanism, hypothesis. Cortex 2022; 149:137-147. [DOI: 10.1016/j.cortex.2022.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/13/2021] [Accepted: 01/19/2022] [Indexed: 01/03/2023]
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Larner AJ. Transient epileptic amnesia and amygdala enlargement revisited. Psychogeriatrics 2021; 21:943-944. [PMID: 34438463 DOI: 10.1111/psyg.12755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/09/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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McGinty RN, Larner AJ. Transient epileptic amnesia and pathological tearfulness. Cortex 2021; 147:206-208. [PMID: 34148639 DOI: 10.1016/j.cortex.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Ronan N McGinty
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom.
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