Transient epileptic amnesia in dementia: A treatable unrecognized cause ofepisodic amnestic wandering

The authors present two patients with dementia who displayed recurrent tran sient episodes of amnestic wandering and disorientation characterized by ge tting lost in familiar environments. At other times these patients did not wander or become disoriented. The inability to recall any information durin g these episodes, and the marked difference of the episodic amnesia exacerb ations from the progressive amnesia characteristic of Alzheimer disease see n in these patients led to their evaluation. These clinical episodes and th e bilateral interictal epileptiform electroencephalographic changes found i n both patients led to the diagnosis of transient epileptic amnesia, a synd rome that can be diagnostically elusive. These transient amnestic wandering events subsided after treatment with antiepileptic drugs in both patients. The authors suggest that transient wandering of this type may be caused by ictal events or postictal confusional states. This report emphasizes the i mportance of recognizing transient epileptic amnesia as an easily treatable cause of episodic behavioral abnormalities responsive to antiepileptic the rapy, especially in those patients who have a markedly inconsistent pattern of wandering, disorientation in familiar settings, and amnesia exacerbatio n manifested by no recall of the emotional stress of getting lost or of any information during these episodes. Recognition of this type of behavioral disruption and its proper treatment can lead to improved quality of life fu r these patients, maintain these patients in their homes and out of chronic care institutions longer, and facilitate the community's and caretaker's i nteractive roles with the patient.