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      Transient Epileptic Amnesia with Preserved Consciousness: a Report of Two Cases

      case-report

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          Abstract

          Transient epileptic amnesia (TEA) is defined as recurrent ictal and interictal transient memory disturbances typically occurring upon waking. Patients with TEA usually cannot remember the episodes. Electroencephalographic (EEG) abnormalities are usually localized on the dominant or bilateral temporal lobes. Here we report two cases of TEA with atypical features. The patients could remember the episodes afterwards, and abnormal discharges on EEG were detected in the temporal lobes of the non-dominant hemisphere. We suggest that confinement of epileptic discharge to the non-dominant temporal lobe can lead to partial preservation of consciousness during seizure attacks that produce transient amnesia.

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          Recent insights into the impairment of memory in epilepsy: transient epileptic amnesia, accelerated long-term forgetting and remote memory impairment.

          A Z Zeman, Christopher Butler (2008)
          Complaints of memory difficulties are common among patients with epilepsy, particularly with temporal lobe epilepsy where memory-related brain structures are directly involved by seizure activity. However, the reason for these complaints is often unclear and patients frequently perform normally on standard neuropsychological tests of memory. In this article, we review the literature on three recently described and interrelated forms of memory impairment associated with epilepsy: (i) transient epileptic amnesia, in which the sole or main manifestation of seizures is recurrent episodes of amnesia; (ii) accelerated long-term forgetting, in which newly acquired memories fade over days to weeks and (iii) remote memory impairment, in which there is loss of memories for personal or public facts or events from the distant past. Accelerated long-term forgetting and remote memory impairment are common amongst patients with transient epileptic amnesia, but have been reported in other forms of epilepsy. Their presence goes undetected by standard memory tests and yet they can have a profound impact on patients' lives. They pose challenges to current theoretical models of memory. We discuss the evidence for each of these phenomena, as well as their possible pathophysiological bases, methodological difficulties in their investigation and their theoretical implications.
          Article 0 comments Cited 68 times – based on 0 reviews     Review now
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            Positive and negative network correlations in temporal lobe epilepsy.

            Paul S Spencer, Colin Studholme, K McNally … (2004)
            Temporal lobe seizures are accompanied by complex behavioral phenomena including loss of consciousness, dystonic movements and neuroendocrine changes. These phenomena may arise from extended neural networks beyond the temporal lobe. To investigate this, we imaged cerebral blood flow (CBF) changes during human temporal lobe seizures with single photon emission computed tomography (SPECT) while performing continuous video/EEG monitoring. We found that temporal lobe seizures associated with loss of consciousness produced CBF increases in the temporal lobe, followed by increases in bilateral midline subcortical structures. These changes were accompanied by marked bilateral CBF decreases in the frontal and parietal association cortex. In contrast, temporal lobe seizures in which consciousness was spared were not accompanied by these widespread CBF changes. The CBF decreases in frontal and parietal association cortex were strongly correlated with increases in midline structures such as the mediodorsal thalamus. These results suggest that impaired consciousness in temporal lobe seizures may result from focal abnormal activity in temporal and subcortical networks linked to widespread impaired function of the association cortex.
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              Impaired consciousness during temporal lobe seizures is related to increased long-distance cortical-subcortical synchronization.

              Luc Valton, Christophe Bernard, Marie Arthuis … (2009)
              Loss of consciousness (LOC) is a dramatic clinical manifestation of temporal lobe seizures. Its underlying mechanism could involve altered coordinated neuronal activity between the brain regions that support conscious information processing. The consciousness access hypothesis assumes the existence of a global workspace in which information becomes available via synchronized activity within neuronal modules, often widely distributed throughout the brain. Re-entry loops and, in particular, thalamo-cortical communication would be crucial to functionally bind different modules together. In the present investigation, we used intracranial recordings of cortical and subcortical structures in 12 patients, with intractable temporal lobe epilepsy (TLE), as part of their presurgical evaluation to investigate the relationship between states of consciousness and neuronal activity within the brain. The synchronization of electroencephalography signals between distant regions was estimated as a function of time by using non-linear regression analysis. We report that LOC occurring during temporal lobe seizures is characterized by increased long-distance synchronization between structures that are critical in processing awareness, including thalamus (Th) and parietal cortices. The degree of LOC was found to correlate with the amount of synchronization in thalamo-cortical systems. We suggest that excessive synchronization overloads the structures involved in consciousness processing, preventing them from treating incoming information, thus resulting in LOC.
              Article 0 comments Cited 47 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Epilepsy Res
                Journal ID (iso-abbrev): J Epilepsy Res
                Title: Journal of Epilepsy Research
                Publisher: Korean Epilepsy Society
                ISSN (Print): 2233-6249
                ISSN (Electronic): 2233-6257
                Publication date Collection: June 2017
                Publication date (Electronic): 30 June 2017
                Volume: 7
                Issue: 1
                Pages: 54-56
                Affiliations
                Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea
                Author notes
                Corresponding author: Jung-Ju Lee, Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, 68 Hangeulbisuk-ro, Nowon-gu, Seoul 01830, Korea, Tel. +82-2-970-8312, Fax. +82-2-974-7785, E-mail; jungju2@ 123456unitel.co.kr
                Article
                Publisher ID: er-7-1-54
                DOI: 10.14581/jer.17010
                PMC ID: 5540692
                SO-VID: 5510ed64-a90e-4b29-99c2-8e4f7e5fb576
                Copyright © Copyright © 2017 Korean Epilepsy Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 February 2017
                Date accepted : 27 February 2017
                Categories
                Subject: Case Report

                Keywords: transient amnesia,epilepsy,dominant temporal lobe
                Data availability:
                Keywords: transient amnesia, epilepsy, dominant temporal lobe

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