Transient epileptic amnesia

This refers to the minority of patients with transient global amnesia in whom epilepsy appears to be the underlying cause of the syndrome. (1„) Where epilepsy has not previously been diagnosed, the main predictive factors for an epileptic aetiology are brief episodes of memory loss (an hour or less) with multiple attacks. (1> It is important to note that standard electroencephalography (EEG) and CT findings are often normal. However, an epileptic basis to the disorder may be revealed on sleep EEG recordings.*4)

Patients with transient epileptic amnesia may show residual deficits in between their attacks, associated with their underlying neuropathology. Kopelman et al.ty found a moderate degree of residual anterograde memory impairment in their patient. Multiple small regions of signal alteration were subsequently found in the medial temporal lobes in this patient, as well as medial temporal hypometabolism on a fluorodeoxyglucose ( FDG) PET scan. Kapur et al/,5> described a single case, in whom they found a residual interictal retrograde amnesia, in the presence of only minor anterograde memory impairment. They interpreted this as a case of 'isolated retrograde amnesia'.

Epilepsy may, of course, give rise to automatisms or postictal confusional states. Where there is an automatism, there is always bilateral involvement of the limbic structures involved in memory formation, including the hippocampal and parahippocampal structures bilaterally as well as the mesial diencephalon. Consequently, amnesia for the period of automatic behaviour is always present and is usually complete.

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