Chronic Visual Abnormality in an Elderly Patient With Temporal Lobe Epilepsy

Area of Science:

• Neurology
• Epileptology

Background:

• Elderly patients often present with nonspecific symptoms that can complicate diagnosis.
• Chronic visual field abnormalities and a floating sensation in a 79-year-old woman prompted investigation.

Observation:

• Neurological and ophthalmologic exams were normal, but MRI revealed left hippocampal atrophy.
• Electroencephalography (EEG) showed left frontotemporal spikes and slow waves.
• ¹²³I-iomazenil single photon emission computed tomography indicated reduced accumulation in the affected region.

Findings:

• A diagnosis of temporal lobe epilepsy was established.
• Treatment with lacosamide led to significant symptom and EEG improvement.

Implications:

• Mild focal seizures can manifest as altered awareness, mimicking ophthalmologic issues.
• Diagnosing epilepsy in older adults requires careful consideration of subtle, non-specific complaints.