Epileptic amnesic syndrome.

Thirteen patients with "epileptic amnesic syndrome" (EAS) presented with adult-senile onset of a severe memory complaint that started before or at the same time as seizures. All were diagnosed as temporal lobe epilepsy (TLE). The seizures were stereotyped, with only short loss of contact and oral automatisms, and because they were not obvious or disturbing, they remained underdiagnosed for a long time. Nine cases also presented attacks of transient anteroretrograde amnesia after the seizures--called "epileptic amnesic attacks" (EAA)--during which the patients were able to perform complex actions. EAA are similar to the attacks of transient global amnesia (TGA) but are more frequent, shorter, accompanied by clear-cut clinical and electroencephalographic epileptic manifestations, and respond favorably to antiepileptic therapy. Neuropsychological investigation ruled out global mental deterioration, showing only selective memory impairment in a few long-term tasks and dissociation between formal findings and the relevant memory complaint. These cases have uniform anamnestic, clinical, and neuropsychological characteristics and represent a particular clinical expression of TLE, namely EAS. We suggest that an epileptic origin be entertained in patients presenting repeated amnesic attacks resembling TGA or who complain of persistent memory disturbance, after more common etiologies have been excluded.

Cognitive effects of antiepileptic drug discontinuation.

We studied the cognitive effects of antiepileptic drugs (AEDs), by investigating epileptic patients who were seizure-free for a long time and who were undergoing fixed monotherapy. Ninety patients [27 with phenobarbital (PB), 18 with carbamazepine (CBZ), 16 with phenytoin (PHT), and 29 with valproate (VPA)] were examined by a neuropsychological battery exploring intelligence, vigilance, attention, memory, and visuomotor performances at full AED dose (T1) and compared to 28 normal volunteers. We also evaluated the effects of AED discontinuation by retesting patients 3 months after reduction at half drug dose (T2) and 3 months (T3) and 1 year (T4) after complete discontinuation. Our findings showed that patients receiving CBZ did not differ from controls at any time of examination. Patients receiving PB had significant differences only at T1 (visuomotor performance and immediate spatial memory). Patients receiving VPA showed differences in attention, visuomotor performance, verbal span and sensory discrimination tasks at T1, in visuomotor performance at T2 and in spatial span at T3, whereas no differences were detected at T4. Patients receiving PHT had a difference in intelligence and visuomotor performance at T1, in intelligence at T2, and no differences at T3 or T4. This study model is useful for investigating the cognitive effects of AED because it allows selection of a uniform sample, eliminating variables such as type, frequency, and gravity of seizures that complicate this kind of study.

Binswanger's disease and normal-pressure hydrocephalus. Clinical and neuropsychological comparison.

We investigated the clinical and cognitive aspects of patients with normal-pressure hydrocephalus and possible Binswanger's disease. We studied 19 patients with normal-pressure hydrocephalus and 19 patients with Binswanger's disease, comparing them with the same number of matched controls. The patients with normal-pressure hydrocephalus had a later age and more frequent gait disturbance at the onset, shorter duration of the illness, rare signs of vascular disturbances, and more frequent severe mental deterioration. Ventricular enlargement may play a role in determining the more rapid and worse clinical course of normal-pressure hydrocephalus.