Monthly Case

Epileptic déjà vu-auras | 12-2013

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A 24-year-old patient reported short episodes with déjà vu for more than 2 years that occur with increasing frequency. In the last weeks, the patient had these episodes daily. His déjà vus are accompanied by smelling perceptions. On inquiry, the patient’s partner reported that déjà vus are followed by episodes with staring, unresponsiveness and slight lip movements. The patient is amnesic for this second part. Now, he suffered the first generalized tonic-clonic seizure. For the first time, this resulted in clinical and additional technical diagnostic procedures. The episodes with déjà vu were classified as epileptic auras evolving to automotor (= complex partial) seizures. Brain MRI revealed a presumably benign tumor in left temporo-mesial structures, representing the cause of this partial epilepsy.

We initiated antiepileptic treatment with levetiracetam, but also high daily doses modified seizure frequency a best modestly. We added lacosamide, the patient is still in dose increase.

A déjà vu (French for “already seen”) is the – often vexing – phenomenonof having the strong sensation that an event currently being experienced has already been experienced in the past. Déjà vus manifest in healthy persons sporadically, the exact neurobiological mechanisms are elusive. In contrast, déjà vus occurring frequently – in particular such as in the current case – in general are manifestations of pathological processes confined to the temporal lobe. As in the current patient episodes with déjà vu unambiguously are followed by automotor seizures, the déjà vu episodes as well are diagnosed to be epileptic. Such episodes are only experienced by the patient himself, they are not seen by witnesses, this defines an epileptic aura.

The benign tumor in the left hippocampus as cause for the patient’s epilepsy does not require resection from a neurosurgeon’s perspective. If the patient does not respond to the second antiepileptic drug and thus fulfils the criteria for pharmacoresistance, the tumor and further parts of the temporal lobe may have to be resected from an epileptologist’s point of view. The overall therapeutic aim is complete seizure freedom.

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