# Chronic Visual Abnormality in an Elderly Patient With Temporal Lobe Epilepsy

## TL;DR

An elderly woman with chronic visual issues was diagnosed with temporal lobe epilepsy, which improved significantly with lacosamide treatment.

## Contribution

Highlights the challenge of diagnosing epilepsy in the elderly through nonspecific symptoms like visual abnormalities.

## Key findings

- Temporal lobe epilepsy was diagnosed based on MRI and EEG findings in an elderly patient with visual complaints.
- Treatment with lacosamide led to significant improvement in symptoms and EEG results.
- Mild focal seizures can mimic ophthalmologic issues, complicating diagnosis in older adults.

## Abstract

A 79-year-old woman visited our department for chronic visual field abnormalities with a floating sensation for two months. Neurological and ophthalmologic examinations yielded normal results, except for brain MRI indicating left hippocampal atrophy. Cognitive function tests were normal. EEG revealed frequent spikes and slow waves in the left frontotemporal region, corroborated by reduced accumulation in 123I-iomazenil single photon emission computed tomography. A diagnosis of temporal lobe epilepsy was established, and treatment with lacosamide resulted in a remarkable improvement in symptoms and EEG findings. Mild focal seizures from the temporal region might cause mild impaired awareness, resulting in the patient’s report as a sensation of uncertainty between the self and the outside world, mimicking ophthalmologic abnormalities. The repeated nature of the seizures contributed to the absence of the term "transient" in symptom description. Diagnosing epilepsy in the elderly proves challenging due to nonspecific complaints.