Temporal lobe seizures (TLS) may transiently impair cognitive and memory function and result in fluctuating memory loss to reflect the ictal-post-ictal continuum. In Alzheimer’s disease, toxic accumulations of A-beta peptides underlies the memory disorder triggering synaptic degeneration, circuit remodeling, and abnormal synchronization within the same hippocampal networks to lead to progressive memory loss1. The neuronal hyperexcitability that is associated with seizures augments the synaptic release of A-beta and may further compound the cognitive deficits in compromised patients such as those with AD. While AD and epilepsy are felt to reflect independent disorders, progressive cognitive and memory deficits are known to occur in patients with TLS associated with hippocampal sclerosis. Furthermore, seizures are a common comorbidity in those with early onset AD. When seizures are subtle, nocturnal, or occur in seniors that expect memory loss, the diagnosis may be elusive. If memory loss fluctuates, subtle TLS without awareness should be considered. In our patient living alone, prolonged EEG had a greater yield than repeated EEG2.
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