Purpose: Mild cognitive impairment (MCI) converts in up to 80% of patients diagnosed with in Alzheimer’s disease after a few years of diagnosis. The identification among such a population of a rare form of epilepsy (transient epileptic amnesia [TEA]), characterized by mixed anterograde and retrograde amnesia with apparent preservation of other cognitive functions, excessively rapid decay of newly acquired memories, and loss of memories for salient personal events of the remote past, strongly affects prognosis and medical treatment. Our aim was to define the clinical utility of routine high-density electroencephalography (EEG) in MCI patients. Methods: 76 consecutive patients with a diagnosis of MCI (Petersen and Negash, 2008) were included and evaluated with hematological screening, neuropsychological testing (Modified Mental Deterioration Battery, Carlesimo et al., 1996), 3T MRI and 256 channels EEG. After collective case revision, final diagnosis of TEA plus accelerated long-term forgetting, as demonstrated by the Rey memory test scores, was made for 3 patients, according to Butler’s diagnostic criteria (2007). The same diagnosis is plausible for a fourth patient, which was more likely at the beginning of her history, followed by a true multiple domain MCI. Results: Using high-density EEG (256 channels), we were able to single out 3 cases of TEA previously misdiagnosed as MCI in this cohort. Antiepileptic treatment effectively stopped the acute episodes of memory loss. The diagnostic yield of high-density EEG recording in these patients instead of standard EEG increased by 0.75, with a diagnostic accuracy of 1. Conclusion: To our knowledge, this is the first report of an incidence of 4 % of TEA recorded in an MCI cohort. TEA incidence may be underestimated in mild cognitive impairment and high-density EEG improved the detection rate of epileptiform abnormalities.
IS ALL WHAT I FORGET ON A DEGENERATIVE BASIS? TRANSIENT AMNESTIC EPILEPSY IN A COHORT OF MILD COGNITIVE IMPAIRMENT PATIENTS: A HIGH DENSITY EEG STUDY
DEL FELICE, Alessandra;MANGANOTTI, Paolo
2014-01-01
Abstract
Purpose: Mild cognitive impairment (MCI) converts in up to 80% of patients diagnosed with in Alzheimer’s disease after a few years of diagnosis. The identification among such a population of a rare form of epilepsy (transient epileptic amnesia [TEA]), characterized by mixed anterograde and retrograde amnesia with apparent preservation of other cognitive functions, excessively rapid decay of newly acquired memories, and loss of memories for salient personal events of the remote past, strongly affects prognosis and medical treatment. Our aim was to define the clinical utility of routine high-density electroencephalography (EEG) in MCI patients. Methods: 76 consecutive patients with a diagnosis of MCI (Petersen and Negash, 2008) were included and evaluated with hematological screening, neuropsychological testing (Modified Mental Deterioration Battery, Carlesimo et al., 1996), 3T MRI and 256 channels EEG. After collective case revision, final diagnosis of TEA plus accelerated long-term forgetting, as demonstrated by the Rey memory test scores, was made for 3 patients, according to Butler’s diagnostic criteria (2007). The same diagnosis is plausible for a fourth patient, which was more likely at the beginning of her history, followed by a true multiple domain MCI. Results: Using high-density EEG (256 channels), we were able to single out 3 cases of TEA previously misdiagnosed as MCI in this cohort. Antiepileptic treatment effectively stopped the acute episodes of memory loss. The diagnostic yield of high-density EEG recording in these patients instead of standard EEG increased by 0.75, with a diagnostic accuracy of 1. Conclusion: To our knowledge, this is the first report of an incidence of 4 % of TEA recorded in an MCI cohort. TEA incidence may be underestimated in mild cognitive impairment and high-density EEG improved the detection rate of epileptiform abnormalities.
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