Monthly Case

A 72-year-old patient has coffee and cake with his wife and suddenly pauses while eating, the fork does not reach his mouth. The wife describes a staring gaze, the patient is unresponsive for 1-2 min. This episode is not accompanied by motor signs. After the end of this episode, the patient is rapidly reoriented. Therefore, his wife does not take this behavioural change seriously. In the following weeks, such episodes with loss of contact reoccur repetitively – while watching TV, while eating or during conversations. Interestingly, these paroxysmal changes are only observed by his woman, the patient himself is amnesic for these events. After some detours, the patients eventually presents in the outpatient clinic of the Epilepsy-Center Berlin-Brandenburg. Based on the excellent descriptions of the patient’s wife, the episodes are diagnosed as automotor (= complex partial) epileptic seizures. EEG shows mild bilateral temporal slowing but not interictal epileptic discharges. Brain MRI reveals moderate cerebral microangiopathy. We made the diagnosis of partial epilepsy and started antiepileptic treatment with lamotrigine. Three months later, his wife reported that the patient is seizure free.

This case illustrates typical characteristics of epilepsy in the elderly. Automotor seizures are rather subtle, lacking obvious motor signs. The patient does not realize his spells, amnesia is part of the seizures. On making the correct diagnosis, patients regularly respond excellently to antiepileptic drugs. It is important to be familiar with these characteristics as new onset seizures and epilepsies become more likely the older patients are.

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