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Transient epileptic amnesia (TEA) is a rare phenomenon in temporal lobe epilepsy that is often unrecognized or misdiagnosed as transient global amnesia (TGA). It is postulated that TEA is due to both ictal and postictal disturbances. Response to antiseizure medication underlines its epileptic nature. In view of the increasing incidence of new-onset epilepsies in old age, an increase in TEA can be expected in the future.Analysis of TEA features in a monocentric case series.A search in our electronic patient data base yielded 10 patients with TEA out of 7899 patients over a period of 8 years. Clinical and paraclinical features as well as findings of additional examinations were retrospectively collected. Data are given as mean ± SD.All 10 patients were diagnosed with temporal lobe epilepsy. The mean age at manifestation of TEA was 59.1 ± 6.7 years, the diagnosis was made with a delay of 21.9 ± 26.3 months. The TEA lasted on average 56 ± 37 min, and 16 ± 9.9 TEA episodes per year were reported by the patients; out of the 10 patients 6 reported that TEA usually occurred upon awakening. In 9 of 10 patients, there was evidence of typical seizure symptoms or other semiological elements during TEA. Interictal neuropsychological disturbances of temporal functions were seen in 8 of 10 patients and evidence of depressive disorder in 6 of 10 patients. Video EEG recordings revealed epileptiform activity during sleep in 4 patients over the left and in 2 patients over both temporal regions. In 3 patients, magnetic resonance imaging displayed typical alterations of the temporomesial structures (in 2 patients on the left and in 1 the right side). Antiseizure medication improved seizure control in 7 of 10 patients (seizure freedom in 6 patients), 3 patients were lost to follow-up.TEA is rare, occurs in older adults and is correctly diagnosed after about 2 years. Thorough assessment of additional symptoms and circumstances, the recurrent occurrence as well as typical EEG and imaging findings of temporal lobe epilepsy enables the distinction between TEA and TGA.HINTERGRUND: Die transiente epileptische Amnesie (TEA) ist ein seltenes Phänomen bei Temporallappenepilepsien, das häufig nicht erkannt oder als transiente globale Amnesie (TGA) fehldiagnostiziert wird. Als Ursache werden iktale und postiktale Störungen der Gedächtnisbildung postuliert, was auch durch das Ansprechen auf Antiepileptika gestützt wird. Angesichts der zunehmenden Zahl neu auftretender Epilepsien im höheren Lebensalter ist auch mit einer Zunahme der TEA zu rechnen.Analyse typischer Merkmale der TEA in einer monozentrischen Fallserie.Mittels interner Datenbankanalyse wurden unter 7899 Patient*innen über einen Zeitraum von 8 Jahren 10 Patient*innen mit TEA identifiziert. Klinische Merkmale sowie Befunde der Zusatzdiagnostik wurden retrospektiv untersucht. Die Daten sind als Mittelwert ± SD angegeben.Bei allen 10 Patient*innen wurde die Diagnose einer Temporallappenepilepsie gestellt. Das Lebensalter bei Erstmanifestation der TEA lag bei 59,1 ± 6,7 Jahren, die Diagnose wurde mit einer Latenz von 21,9 ± 26,3 Monaten gestellt. Eine TEA-Episode dauerte 56 ± 37 min an und trat pro Jahr 16 ± 9,9-mal auf; 6 von 10 Patient*innen berichteten über häufiges Auftreten direkt nach dem Erwachen. Bei 9 von 10 Patient*innen wurde über weitere Anfallstypen bzw. weitere semiologische Elemente während der TEA berichtet. Hinweise auf neuropsychologische Störungen temporaler Funktionen ergaben sich bei 8 von 10 Patient*innen, Hinweise auf eine depressive Störung bei 6 von 10 Patient*innen. Im Schlaf aktivierte epilepsietypische Aktivität wurde bei 4 Patient*innen temporal links sowie bei 2 Patient*innen temporal beidseits nachgewiesen. Bei 3 Patient*innen wurden mittels Kernspintomographie typische Auffälligkeiten im Bereich der temporomesialen Strukturen (bei 2 links, bei 1 rechts) nachgewiesen. Eine antiepileptische Therapie verbesserte die Anfallskontrolle bei 7 von 10 Patient*innen (Anfallsfreiheit bei 6 Patienten), bei 3 Patienten ist die therapeutische Wirkung unbekannt.TEA sind selten, treten im höheren Erwachsenenalter auf und werden erst nach etwa 2 Jahren korrekt als epileptisches Phänomen diagnostiziert. Die gründliche Erfassung von Begleitsymptomen, die Umstände und das rezidivierende Auftreten sowie Hinweise auf eine Temporallappenepilepsie in den apparativen Zusatzuntersuchungen ermöglichen die Differenzierung zur TGA.

Memory Loss - a Case of Sudden Amnesia

The concept of “hysteria” comes from the Greek word “hystera” (uterus) and dates back to the time of Hippocrates, at least. Modern classifications differ regarding the area encompassed by the concepts of dissociation and conversion differ. Mental health professionals in the United States (DSM-5) use a standard classification of mental disorders codifying dissociative disorders as a distinct class of disorders, but subsumes conversion disorders under “somatoform disorders”. The history of hysteria is as long as the history of mankind. Apparently, both the essence and mechanisms of dissociative disorders remain unchanged despite the fact that many years have passed. According to Owczarek et al., dissociative symptoms are caused by the malfunctioning of defence mechanisms and anxiety. This article provides an overview of the available literature on the etiology and pathogenesis of dissociative disorders as well as disorders such as amnesia, dissociative fugue, trance and possession.

This paper presents a short summary of the knowledge on marine biotoxins. As toxins are known for their acute effects, they have been classified here according to the effects they cause in acute human poisoning incidents. Toxins may thus be distinguished into those that affect the nervous system (paralytic and other neurotoxins), memory (amnesic poisons), and the digestive system (diarrhetic toxins). Furthermore, newly emerging toxins, such as ciguatoxins or shark toxins, and factors that lead to the introduction of toxins in new areas, are presented. Relevant suggestions for further reading are given., Dieser Beitrag stellt eine Kurzfassung der Kenntnisse über marine Biotoxine dar. Da die Toxine durch ihre akuten Wirkungen bekannt sind, wurden sie hier nach ihrer Wirkung beim Menschen im Vergiftungsfall eingeteilt. Man unterscheidet sie nach der Wirkung auf das Nervensystem (lähmende und andere Neurotoxine), das Gedächtnis (amnesische Toxine) und das Verdauungssystem (Durchfall auslösende Toxine). Weiterhin werden neu auftretende Toxine, wie z. B. Ciguatoxine oder Toxine in Haifischfleisch, und Faktoren, die zum Erscheinen von Toxinen in neuen Gebieten führen, aufgeführt sowie relevante Hinweise auf weiterführende Literatur gegeben.

History and admission findings | A 41year old woman presented at our internistic clinic after treatment by an emergency doctor because of confusion and amnesia accompanied by a hypoglycaemic episode while driving her car. Only by giving continuous glucose intravenously a stable clinical state could be achieved. In her medical history she took Lamotrigin for 12 years since she had seizures of unknown aetiology. 16 years ago she had similar sudden attacks with confusion and hypoglycaemia. At that time thorough diagnostics at the clinic for internal medicine did not reveal any evidence for hyperinsulinaemia. While taking Lamotrigin the patient had no seizures or similar symptoms for 12 years. Treatment and course | In the present case we detected a tumor in the pancreas and a two-fold increased insulin secretion. Histopathological work-up of the removed tissue confirmed the suspected diagnosis of insulinoma. Postoperatively, Lamotrigin treatment was terminated. Since then the patient remained asymptomatic.

Unilateral cerebral ischemia of the hippocampus is very rare. This paper reviews the literature and presents the case of a 59-year-old woman with an amnestic syndrome due to a left hippocampal stroke. The patient suffered from retrograde amnesia which was most severe over the 2 days prior to presenting and a slight anterograde amnesia. In addition, a verbal memory disorder was confirmed 1 week after admission by neurological tests. As risk factors, arterial hypertension and a relative hyper-beta lipoproteinemia were found. This case shows that unilateral amnestic stroke, e.g. in the hippocampus region, may be the cause of an amnestic syndrome and should be included in the differential diagnostics.

This article deals with the question why experts quite frequently arrive at totally opposite judgements in clinical psychotraumatological expert opinions. This often leads to intense controversially conducted arguments resulting in lengthy proceedings. The reasons for this will be presented for two cases taken from expert opinions issued for the "Soziales Entschädigungs- und Ausländerrecht" (Laws for Social Reparations and Foreigners). A brief synopsis on the legal background will be given and solutions suggested.

In the context of criminal forensic evaluations, experts are often confronted with the problem of offenders' claims of crime-related amnesia. Because of the far-reaching legal consequences of the expert opinion, the nature of the suspected memory disorder has to be investigated with special care and due consideration of differential diagnoses. While the diagnosis of organic amnesia is comparatively easy to make, the same is not true for dissociative amnesia. Despite existing theoretical explanations such as stress, peritraumatic dissociation or repression, to date there is no sound, scientifically based and empirically supported explanation for the occurrence of genuine, non-organic crime-related amnesia. In the criminal context of claimed amnesia, secondary gain is usually obvious; thus, possible malingering of memory loss has to be carefully investigated by the forensic expert. To test this hypothesis, the expert has to resort to methods based on a high methodological level. The diagnosis of dissociative amnesia cannot be made by mere exclusion of evidence for organic amnesia; instead, malingering has to be ruled out on an explicit basis.

Based on a 3-year sample of expert opinions concerning the question of complete intoxication (n = 90), methodology and results are presented. Since more than half of the offenders (n = 53) claim amnesia regarding the circumstances of the offence, this subjective amnesia is considered methodologically. If the file contains observations on the offender's behaviour, it is generally possible to assess if the offender was still able to self-reflect and act in a purposeful way. If so, complete intoxication must be negated independent of the objective degree of alcohol or drug intoxication, and the subjective amnesia claimed by the offender is implausible. In the assessment procedure of complete intoxication a decision tree is used. 37/90 offenders showed no significant memory impairment as well as no psychiatric diagnosis, thus excluding both criminal irresponsibility and complete intoxication. The assessment of subjective amnesia and total intoxication was based on the following information from the decision tree: in 51 (47 males, 4 females) of the 53 offenders claiming subjective amnesia the file contained behavioural observations at the time of the offence. Only in two cases, a considerable lack of information prevented a clear decision regarding the question of complete intoxication. Despite the fact that only in about 50% of the offenders claiming subjective amnesia evidence of alcohol or drug influence was demonstrated according to the files, the question of complete intoxication could be successfully evaluated in all but two cases according to the decision tree.

Functional magnetic resonance imaging (fMRI) is frequently used in the presurgical diagnostic procedure of epilepsy patients, in particular for lateralization of speech and memory and for localization of the primary motor cortex to delineate the epileptogenic lesion from eloquent brain areas. fMRI is one of the non-invasive procedures in the presurgical diagnostic process, together with medical history, seizure semiology, neurological examination, interictal and ictal EEG, structural MRI, video EEG monitoring and neuropsychology. This diagnostic sequence leads either to the decision for or against elective epilepsy surgery or to the decision to proceed with invasive diagnostic techniques (Wada test, intra-operative or extra-operative cortical stimulation). It is difficult to evaluate the contribution of the fMRI test in isolation to the validity of the entire diagnostic sequence. Complications such as memory loss and aphasia in temporal lobe resections or paresis after frontal lobe resections are rare and rarely of disastrous extent. This further complicates the evaluation of the clinical relevance of fMRI as a predictive tool. In this article studies which investigated the concordance between fMRI and other diagnostic gold standards will be presented as well as the association between presurgical fMRI and postsurgical morbidity.

The development of memory research is inextricably bound to the fate of patient HM. On the occasion of his death, the circumstances are remembered, which lead to the bilateral removal of parts of his medio-temporal cortex in 1953. And the importance of the subsequent more than a half-century of research about his postoperative amnesic deficits as well as remaining learning and memory functions are outlined. The early reports triggered improved animal research which together with parallel investigations on HM and patients with similar deficits eventually lead to the downfall of the up until then dominating antilocalisationist view of brain functions. This was the result of having convincingly shown that memory could be severely impaired without major changes in other cognitive functions. Later investigations lead to question the unity of memory itself and forced a more and more differentiated description of different kinds of memory and their associations with separate neuroanatomical structures. A simplified summary of the resulting recent ideas of declarative memory systems is presented together with an outline of connections to their supporting medio-temporal, diencephalic and frontal-cortical structures. Finally, an attempt is made to address the question about the impact on the person HM of not having been able to form consciously retrievable memories from age 27 until his death at age of 82, thus having to rely for a reconstruction of his life on memories from child- and young adulthood as well as single momentary short-lived experiences.

In the present study we examined the facial affective behaviour of acute adult-onset traumatized patients versus childhood-onset traumatized patients. Furthermore, we analyzed whether a decrease in emotional numbing results from a reduction of symptoms. We used amnestic tendencies as a moderator variable.The facial affective behaviour was coded with the Emotional Facial Acting Coding System, an instrument for the registration of facial movements with emotional relevance. The facial affective behaviour of the patient's first and last EMDR sessions was compared.Childhood-onset and acute adult-onset traumatized patients showed the same reduction of overall facial activity. We found significantly higher psychic complaints (global severity index) (SCL-90-R) in childhood-onset traumatized patients and no difference in amnestic tendencies (FDS) between the two groups. Childhood-onset traumatized patients showed higher values of derealisation (FDS).The facial affective reduction remains constant over time. Also childhood-onset traumatized patients developed more psychic complaints and greater derealisation.

Physiological and pathologic changes of various body functions have a great influence on the cognitive performance of a human being in the course of aging. Knowledge-based neuropsychological abilities do not change much during the physiological aging process. However, the decreasing capacity of the working and sensory memory lead to lesser attention and learning performance in the elderly, compared to younger population groups. Pathological mental function changes correlate with the existence of certain physical diseases, the most important of which show an increasing incidence with old age. Degenerative diseases especially Alzheimer's disease and other demential syndromes as well as vascular diseases of the central nervous system, tumors, inflammation, epilepsy, traumatic as well as metabolic and toxic damages to the central nervous system can affect cognitive and physical function to a high degree. Prevention in old age plays a key role. The therapeutic approach to the cognitive disorder is selected according to the disease stage and should be multiprofessional, including the best applicable medical and nonmedical treatment and support for the patient and his family.

The case of a female dextral patient (MN) is reported. MN sustained a partial frontotemporal infarction in the right hemisphere. Clinically, MN presented herself mainly with aphasic symptoms. The dextrality of the patient and the laterality of the lesion as well as the nature of language deficits would legitimate the diagnosis of a crossed aphasia, implying paradoxical lateralization of language in MN. However, comprehensive neuropsychological assessment revealed the presence of a global dysexecutive syndrome in MN, suggesting a general cognitive impairment, part of which must be the aphasic symptoms. General issues regarding the relationship between language and cognition and the lateralization of cognitive functions are discussed.

We report a court verdict in the second retrial of a murder case that was based exclusively on the witness account of a severely brain damaged victim, and its reversal by the German Federal Court. The assessment of evidence had to weigh up the probability of the presence of real accounts of the crime versus the possibility of alternative explanations, i. e. trauma related confabulation. The defendant was acquitted.

In the present study we examined facial affective behavior in acutely traumatized patients undergoing EMDR therapy. Furthermore, we analyzed whether a decrease in emotional numbing was due to a reduction of symptoms. Amnestic tendencies were used as a moderator variable.The facial affective behaviour was coded using the Emotional Facial Acting Coding System, an instrument for the registration of facial movements with emotional relevance. The facial affective behavior of the patient's first and last EMDR session was compared.A significant increase in facial affective behavior as well as an increase in mental complaints were found. Furthermore, the reduction in amnestic tendencies did not result in a reduction of symptoms.Under the influence of the treatment it is possible to improve access to episodic affective memory. Nevertheless, a positive influence cannot be denoted at the end of the treatment.

People with MCI suffer from a moderate memory impairment, from deficits in attention and cognitive flexibility but do not fulfil the diagnostic criteria of dementia. These patients feel forgetful, and sometimes may have problems with their jobs and families because of their forgetfulness. In many cases (10-15% per year), MCI is leading to Alzheimer's disease. The sooner MCI is diagnosed and treated, the better the transition into Alzheimer's disease may perhaps be delayed. The diagnostic instruments are the same as for the diagnosis of Alzheimer's disease: biomarkers of the cerebrospinal fluid, neuroimaging and neuropsychological testing. Neuropsychological testing already shows deficits, even when neuroimaging findings still seem to be normal. Therapy of MCI is basically like the treatment of Alzheimer's disease: symptomatic treatment with cholinesterase-inhibitors or antioxidants, and compensatory psychological approaches.

This study describes the clinical features of presenile dementia diagnosed in memory clinics. It further gives an estimate of the declared incidence for the German city of Munich and surrounding counties. Twelve memory clinics in Switzerland and Germany were considered, among them all of the four in Munich. A total of 267 patients with onset of illness under the age of 65 were included. Only 16 patients (6%) were younger than 50. Men and women were affected about equally often. The most common cause of dementia was Alzheimer's disease (67%), followed by frontotemporal degeneration (13.5%) and vascular (5.6%) dementia. The declared incidence was estimated at 8.3 new cases of dementia per year among 100,000 persons in the 50-64 age range, with an incidence rate of Alzheimer's disease at 6.3/100,000. It can be concluded that memory clinics fulfill an important function in the care of patients with presenile dementia, since they are highly utilized by younger patients in early stages of the illness.