Dementia and Seizures

Abstract

A 64-year-old right-handed Caucasian female developed an insidious onset of progressive difficulties with her memory. Early spells of visual distortion were noted where she said her vision would “seizure up.” Memory rapidly deteriorated as visual loss progressed. She was unable to remember daily activities, though it fluctuated from day to day. She became unable to keep her appointments and began pulling away from contact with her family. Her daughters became concerned and increased the level of family supervision 4–5 months later. Personality changes then became notable. She became less outgoing, more apathetic and withdrawn, and was less gregarious than her “typical self.” Mobility problems interceded and she began to complain of balance issues. She deteriorated to the point where she would be “found down” requiring frequent assistance from others. She was seen by neurology and diagnosed with Alzheimer’s disease (AD) but failed to improve despite donepezil. Concerns for seizures were raised and she was referred for assessment. On evaluation, she was seated in a wheelchair and withdrawn with limited spontaneous interaction. Impairment in memory, visual fixation and pursuit, rapid alternating movements, and gait ataxia was evident. A brain CT was normal. A routine EEG is presented in Fig. 26.1. MRI was pending.