A case of elderly onset partial epilepsy with sleep-related violent seizures associated with amygdalar enlargement

Abstract

Degenerate diseases such as cerebrovascular disorder, tumor, and dementia are the common causes of elderly onset epilepsy. However, reports suggesting an association with amygdalar enlargement have been published recently. We report a case of elderly onset partial epilepsy accompanied by amygdalar enlargement. A 67 year-old man was admitted for investigation of nocturnal abnormal motions. From around 64 years of age, the patient started having "attacks of sudden violent motions" during sleep at night. Meanwhile, he also started to show symptoms including amnesia and impaired sense of smell. Dementia or sleep apnea syndrome was diagnosed in another hospital but treatment did not resolve the symptoms. After admission to our center, detailed investigations including video-EEG led to a diagnosis of elderly onset partial epilepsy. Treatment with carbamazepine resulted in resolution of seizures and improvement of amnesia and smell disorder. Right amygdalar enlargement is observed in this patient. From previous case reports and results of kindling rat experiments, we speculate that the amygdala might be subjected to some kind of kindling stimulus and the excitation spread to the anterior cingulate gyrus causing the violent seizures.