Epileptic Amnesic Syndrome revealing Alzheimer's disease

Objective: To describe the aetiology of a particular form of late-onset temporal lobe epilepsy (TLE) - the Epileptic Amnesic Syndrome (EAS) - that can be responsible for cognitive decline. The syndrome is considered as a reversible cause of memory disturbances, but some patients remain unrelieved despite anticonvulsants. Design: 4 case-reports and a brief discussion. Setting: University Hospital. Patients: 4 patients fulfilling the diagnosis criteria of EAS but for whom a progressive causative disease was suspected because they still complained from their memory after antiepileptic treatment. Results: All patients had characteristics suggesting Alzheimer's disease. Memory disturbances were systematically combined with other non-episodic cognitive impairments. CSF biomarkers were compatible with AD pathological changes. Moreover, brain MRI showed temporal lobe atrophy and neurological examination showed subtle abnormalities in all 4. Conclusion: AD should be kept in mind even though the patients meet the clinical criteria of EAS. This short series highlights the clinical characteristics that should be considered as "red-flags" in EAS patients because their presence makes the diagnosis of EAS improbable. In such a situation, particularly when cognitive improvement is lacking under treatment, a lumbar puncture is warranted. (C) 2012 Elsevier B.V. All rights reserved.