Epilepsia, 45(11):1459–1460, 2004
Blackwell Publishing, Inc.

C 2004 International League Against Epilepsy
Original Letters
A Case of Postictal Transient Anterograde
and Retrograde Amnesia
∗ Geneviève Maheu, †‡Claude Adam, †Paule Hazemann,
†Michel Baulac, and †‡§Séverine Samson
∗ Centre de Neuroscience de la Cognition, Université du Québec à Montréal, Canada; †Epilepsy Unit, Salpêtrière Hospital,
‡CNRS–UPR 640, Paris; §URECA, University of Lille 3, Lille; and //INSERM–EMI 0224, Paris, France
We report the uncommon case of a 27-year-old man
with transient epileptic amnesia (TEA) with long-lasting
episodes. Seizures (one to five monthly) began 2 years af-
ter the spectacular recovery from a cerebral hemorrhagic
contusion with coma for 1 month at age 18 years. The usual
manifestation of his seizures is an ascending wave from
the abdomen. At age 25 years, he had his first grouped
seizures (20 to 30 within 3 days), resulting in an amnesic
state, which reoccurred 10 times since then. Magnetic
resonance imaging (MRI) revealed multiple punctiform
hemosiderin deposits in the white matter underlying the
pars triangularis of the right frontal lobe and the right pos-
teromedial parietal lobe, as well as lesions in the right
amygdala and entorhinal cortex.
During video-EEG monitoring, we recorded 28 seizures
(0.5–3 min), spread over a period of 3 days, starting in
the anterior right hemisphere, involving secondarily the
left side, with occasionally a temporal predominance. We
completed a neuropsychological evaluation before these
grouped seizures. Almost all nonmemory scores were
within 1 SD of the mean. Immediate memory perfor-
mances revealed minor difficulties. Delayed memory tests
demonstrated deficits in recall but not recognition. Perfor-
mances for autobiographic events and personal semantic
memories showed no interictal difficulty (Table 1).
The second memory evaluation (Table 1), carried out
on the first 2 postictal days when the EEG was completely
normal, revealed severe memory impairments in immedi-
ate recall (50% less information recalled than interictally)
and in delayed recall. For some tasks, no material could
be evoked, but recognition was spared. Retrograde mem-
ory assessment was based on autobiographic memories
Accepted July 4, 2004.
Address correspondence and reprint requests to Dr. S. Samson at
URECA, Université de Lille 3, Pont de Bois, F-59 653 Villeneuve d’Ascq
Cedex, France. E-mail: samson@univ-lille3.fr
1459
collected interictally, by providing the necessary minimal
clue to elicit each memory. When no memory could be
evoked, additional clues were given. Remote memory of
events before his traumatic cerebral contusion showed a
good report. By contrast, memories occurring after his
trauma and his first seizure (at age 20 years) required ad-
ditional clues and were poorly reported, those from the
last 4 months being not reported at all. Thus a tempo-
ral gradient for autobiographic events was observed. Per-
sonal semantic memories were equivalent to the interictal
memories. Two weeks later, his mother reported very lit-
tle improvement, but interictal abilities were recovered 2
months later.
His TEA includes anterograde and retrograde amne-
sia. EEG established that his amnesia is postictal and thus
analogous to Todd’s paralysis. Few cases of unusual func-
tional paralysis after seizures have been reported: one with
apraxia, and one with hemineglect lasting for >70 h (1).
The particularly long amnesia (weeks) and the early ap-
parition of TEA (at age 25 years) contrast with previously
reported TEA cases (2–5).
His anterograde memory reveals good recognition but
impaired recall performance, suggesting retrieval difficul-
ties with preserved encoding abilities. Such dissociations
have been explained by frontal lobe dysfunctions (6–9). In
this patient, the presence of frontal lobe lesions and the fact
that seizures start in anterior regions might be responsible
for these findings.
The transient retrograde amnesia documented here se-
lectively affects memories acquired after, but not before,
his head trauma or his first seizure or both. These mem-
ories appear to be particularly vulnerable to TEA. The
temporal gradient associated with transient retro-
grade amnesia suggests that the dysfunction interferes
with hippocampal consolidation (10), arguing for a
mediotemporal-related deficit.
1460 G. MAHEU ET AL.

TABLE 1. Neuropsychological results for memory assessment of a well-educated (MBA level) patient with TEA
Tests Interictal scores Postictal scores Control mean (SD)

Verbal memory tests

Digit span 5 4 6.5 (1.4)
Logical memory (WMS-R)
Immediate recall 8/25 7/25 12.5 (3.5)
Delayed recall (90 min) 5.5/25 0/25 10.5 (3.5)
Associated learning (WMS-R)
Recall 1 to 3 7, 9, 9/10 5, 6, 5/10 7-10 (0.5)
Delayed recall (90 min) 8/10 2/10 9.5 (1)
Auditory Verbal Learning Test (Rey)
Recall 1 to 5 7, 10, 8, 9, 9/15 8-14 (1.5)
Interference list recall 5/15 8 (1.8)
6th recall 10/15 13.5 (1.8)
Delayed recall (30 min) 8/15 13.5 (1.9)
Recognition, false 15/15, 3 15 (0.3)
13 abstract words (Jones-Gotman)
Recall 1 to 4 3, 6, 10, 10/13 3, 4, 6, 6/13 8-12 (1.3)
Delayed recall (24 h) 5/13 0/13 11 (1.5)
24 sentences, recognition (BEM144) 10.5/12 9 (1.5)
Visuo-spatial memory tests
Visual span (Corsi blocs) 6 5 5.5 (1.1)
Rey-Osterrieth Complex Figure
Copy 32.5/36 32/36 32 (2)
Delayed recall (40 min) 15/36 3/36 22 (5)
Visual Reproduction (WMS-R)
Immediate recall 12 (ss) 10 (3)
Delayed recall 8 (ss) 10 (3)
Aggie figures
Recall 1 to 5 2, 7, 9, 11, 12/15 7.5-14 (1.6)
Interference list recall 4/15 7 (2.1)
6th recall 10/15 13.5 (1.2)
Delayed recall (30 min) 11/15 14 (1.2)
Recognition, false 15/15, 0 15 (0.3)
24 drawings, recognition (BEM144) 12/12 9 (1.5)
Face recognition (WMS-III)
Immediate recognition 11(ss) 10 (3)
Delayed recognition (30 min.) 13 (ss) 10 (3)
Face recognition (Warrington) 49/50 45 (3.5)
Autobiographical Memory Test (Kopelman)
Autobiographic incidents
Childhood 9/9 a 8
Early adult 9/9 a 8
Recent 8/9 a 8.5
Personal semantic memory
Childhood 16/21 a 18.5
Early adult 15/21 a 19
Recent 19/21 a 21

Some memory tests providing redundant information are excluded from the table.
ss, Scaled Score of Weschler Memory Scale–Revised.
a These scores cannot be calculated because of the nonstandard retest condition.

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Epilepsia, Vol. 45, No. 11, 2004