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KMID : 0960920020010020143
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Dementia and Neurocognitive Disorders
2002 Volume.1 No. 2 p.143 ~ p.149
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A Case of Epileptic Pseudodementia
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Cho Hyung-In
Jeong Yong
Kang Sue-Jin
Chin Ju-Hee
Yoon Soo-Jin
Seo Dae-Won
Na Duk-Lyul
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Abstract
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Epileptic pseudodementia refers to a condition in which elderly patients present with memory disturbance due to unrecognized complex partial seizures. Memory disturbances in these patients can manifest in two ways: discrete episodes of amnesia, or an insidious fluctuating course of memory dysfunction, simulating dementia. Cases of epileptic prepseudodementia have rarely been reported so far. We herein report a patient who presented with progressive dementia and personality change associated with complex partial seizure. A 68-year old previously healthy man with 16 years of school education visited our memory disorder clinic because of memory disturbance and changes in personality. These symptoms developed insidiously and progressed quite rapidly over 6 months without fluctuation. Detailed history revealed that he occasionally mumbled or smacked his lips with facial flushing during watching TV or conversation. Neurological examinations were within normal limits except for the decreased MMSE score (21/30). Neuropsychological tests were significant for profound memory loss accompanied by mild anomia and frontal executive dysfunction. Brain MRI showed high signal intensities in bilateral (left worse than right) hippocampus and amygdala on T2WI and FLAIR images. Brain F18-FDG PET revealed a focal hypermetabolism in the left mesial temporal area. Initial surface EEG was normal but prolonged EEG monitoring showed intermittent epileptiform discharges originating from the left temporal lobe. Despite seizure-free state after treatment with antiepileptic drug, his cognitive impairments persisted for about 13 months and then began to improve gradually. Unlike the previous epileptic pseudodementia cases who had only memory disturbance, our case showed dementia associated with complex partial seizures. We learn from this case that the possibility of epileptic pseudodementia should be considered when elderly patients present with memory disturbance or dementia of atypical course, especially because complex partial seizure is often unrecognized without detailed history and epileptic pseudodementia is a reversible cause of memory dysfunction.
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KEYWORD
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Epileptic pseudodementia
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