Prolonged spontaneous complex visual hallucinations and illusions as ictal phenomena

Area of Science:

• Neurology
• Neuroscience
• Clinical Medicine

Background:

• Epilepsy is a neurological disorder characterized by recurrent seizures.
• Complex visual hallucinations and illusions (CVHIs) can be ictal or postictal phenomena.
• The differential diagnosis of prolonged CVHIs requires careful consideration of underlying etiologies.

Observation:

• A patient presented with a generalized tonic-clonic seizure followed by persistent CVHIs.
• The patient reported 19 distinct complex visual hallucinations and illusions over several weeks.
• Electroencephalograms (EEGs) demonstrated concurrent right temporal rhythmic activity during CVHIs.

Findings:

• The CVHIs and abnormal EEG findings were directly correlated with seizure activity.
• Treatment with antiepileptic drugs (AEDs) led to the resolution of CVHIs and EEG normalization.
• Discontinuation of AEDs precipitated a recurrence of both CVHIs and EEG abnormalities.

Implications:

• This case highlights a potential ictal or postictal manifestation of epilepsy presenting as prolonged CVHIs.
• It underscores the importance of EEG monitoring in patients with unexplained visual disturbances following seizures.
• Effective management with AEDs suggests a focal epileptic origin for these complex visual phenomena.